Provider Demographics
NPI:1285948927
Name:AGUILUZ MEDICAL CORPORATION, INC
Entity type:Organization
Organization Name:AGUILUZ MEDICAL CORPORATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:AGUILUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:562-533-3279
Mailing Address - Street 1:10970 SHERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-1002
Mailing Address - Country:US
Mailing Address - Phone:818-847-1007
Mailing Address - Fax:
Practice Address - Street 1:10970 SHERMAN WAY
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-1002
Practice Address - Country:US
Practice Address - Phone:818-847-1007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-05
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7451208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty