Provider Demographics
NPI:1407371230
Name:AGUILAR, MARIA IMAILIN AALA
Entity type:Individual
Prefix:
First Name:MARIA IMAILIN
Middle Name:AALA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARIA IMAILIN
Other - Middle Name:AGUILAR
Other - Last Name:DANDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12471 NW 15TH PL APT 16308
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-5230
Mailing Address - Country:US
Mailing Address - Phone:954-240-5780
Mailing Address - Fax:
Practice Address - Street 1:1525 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-3162
Practice Address - Country:US
Practice Address - Phone:815-672-4516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2019-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1256898225100000X
IL070021979225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist