Provider Demographics
NPI:1396089397
Name:AGUILAR, GABRIEL R (PA-C)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:R
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2023 VALE ROAD
Mailing Address - Street 2:#107
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806
Mailing Address - Country:US
Mailing Address - Phone:510-215-9092
Mailing Address - Fax:
Practice Address - Street 1:2023 VALE RD
Practice Address - Street 2:#107
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3834
Practice Address - Country:US
Practice Address - Phone:510-215-9092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant