Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | DC15115 | CA |
N | 111NX0100X | Occupational Health | DC15115 | CA |
NPI | 1417939042 |
---|---|
Provider Name | Dr. Samuel Ramon Aguilera |
First Address | Riverside, CA 92507-6000 |
Second Address | Riverside, CA 92507-6000 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2005 |
Last Update Date | 23/02/2009 |