Provider Demographics
NPI:1205882164
Name:AGUILA, ZENOBIO (MD)
Entity type:Individual
Prefix:
First Name:ZENOBIO
Middle Name:
Last Name:AGUILA
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 1:1101 TAMIAMI TRAIL S.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4133
Mailing Address - Country:US
Mailing Address - Phone:941-480-2800
Mailing Address - Fax:941-480-2820
Practice Address - Street 1:333 TAMIAMI TRAIL S.
Practice Address - Street 2:SUITE 102
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2424
Practice Address - Country:US
Practice Address - Phone:941-485-4858
Practice Address - Fax:941-485-5261
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84823207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264601300Medicaid
FL264601300Medicaid
FL13776SMedicare ID - Type Unspecified