Provider Demographics
NPI:1780319541
Name:AGUILA MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:AGUILA MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-417-4543
Mailing Address - Street 1:1330 KAREN AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89169-1260
Mailing Address - Country:US
Mailing Address - Phone:702-417-4543
Mailing Address - Fax:702-989-4809
Practice Address - Street 1:9280 W SUNSET RD STE 414
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4862
Practice Address - Country:US
Practice Address - Phone:702-906-4800
Practice Address - Fax:888-651-4727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-17
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1780319541Medicaid