Provider Demographics
NPI:1972907228
Name:JORGE A. AGUINAGA, MD
Entity type:Organization
Organization Name:JORGE A. AGUINAGA, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:AGUINAGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-923-9030
Mailing Address - Street 1:471 US HIGHWAY 1
Mailing Address - Street 2:SUITE 104
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5625
Mailing Address - Country:US
Mailing Address - Phone:305-923-9030
Mailing Address - Fax:305-745-9875
Practice Address - Street 1:471 US HIGHWAY 1
Practice Address - Street 2:SUITE 104
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-5625
Practice Address - Country:US
Practice Address - Phone:305-923-9030
Practice Address - Fax:305-745-9875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00770502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2715902-00Medicaid
FL46332Medicare PIN