1679125686 NPI number — DR. RODOLFO ANTONIO AGUILAR PMHNP-BC

Table of content: DR. RODOLFO ANTONIO AGUILAR PMHNP-BC (NPI 1679125686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679125686 NPI number — DR. RODOLFO ANTONIO AGUILAR PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGUILAR
Provider First Name:
RODOLFO
Provider Middle Name:
ANTONIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP-BC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679125686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18291 N PIMA RD STE 110-330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85255-5697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-702-1420
Provider Business Mailing Address Fax Number:
480-718-7720

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7272 E INDIAN SCHOOL RD STE 540
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85251-3996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-702-1420
Provider Business Practice Location Address Fax Number:
480-718-7720
Provider Enumeration Date:
07/10/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP142768 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 209.019899 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 1652 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 231793 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)