Provider Demographics
NPI:1316073448
Name:AGUILERA, MARIJO NICOLE (MD)
Entity type:Individual
Prefix:
First Name:MARIJO
Middle Name:NICOLE
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIJO
Other - Middle Name:NICOLE
Other - Last Name:SOREM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-293-8100
Mailing Address - Fax:651-293-8106
Practice Address - Street 1:205 WABASHA ST S
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55107
Practice Address - Country:US
Practice Address - Phone:651-293-8100
Practice Address - Fax:651-293-8105
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN51556207VX0000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics