Provider Demographics
NPI:1598584187
Name:AGUILAR, MICHELLE (MDS, RDN, LD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:MDS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16002 GINO PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-6618
Mailing Address - Country:US
Mailing Address - Phone:210-708-4591
Mailing Address - Fax:
Practice Address - Street 1:1100 NW LOOP 410
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2263
Practice Address - Country:US
Practice Address - Phone:469-294-9175
Practice Address - Fax:469-294-9175
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91045133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered