Provider Demographics
NPI:1538348909
Name:AGUILERA, RICHARD GLENN GARCIA (MD)
Entity type:Individual
Prefix:
First Name:RICHARD GLENN
Middle Name:GARCIA
Last Name:AGUILERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21940 BRIARWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW PARK
Mailing Address - State:OH
Mailing Address - Zip Code:44126-2659
Mailing Address - Country:US
Mailing Address - Phone:440-716-8734
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # S31
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-1900
Practice Address - Country:US
Practice Address - Phone:216-445-4976
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-01
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57013235208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation