Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 95018916 | CA |
NPI | 1093475543 |
---|---|
Provider Name | Vladimir Aguilar |
First Address | Lake Elsinore, CA 92530-9106 |
Second Address | Lake Elsinore, CA 92530-9106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/12/2021 |
Last Update Date | 25/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95018916 | (05) | CA |