Basic Information
| Provider Information | |||||||||
| NPI: | 1588169007 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUILAR | ||||||||
| FirstName: | VERONICA | ||||||||
| MiddleName: | ELISA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14642 NEWPORT AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927806058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142470300 | ||||||||
| FaxNumber: | 7142591598 | ||||||||
| Practice Location | |||||||||
| Address1: | 14642 NEWPORT AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | TUSTIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927806058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142470300 | ||||||||
| FaxNumber: | 7142591598 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2018 | ||||||||
| LastUpdateDate: | 10/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A167212 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.