Provider Demographics
NPI:1063927846
Name:AGUILERA, VIANCA
Entity type:Individual
Prefix:
First Name:VIANCA
Middle Name:
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14402 SW 108TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6600
Mailing Address - Country:US
Mailing Address - Phone:305-764-2218
Mailing Address - Fax:
Practice Address - Street 1:11700 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-3601
Practice Address - Country:US
Practice Address - Phone:305-961-1319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-03
Last Update Date:2017-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist