Provider Demographics
NPI:1619725033
Name:AGUILERA HERNANDEZ, IRVIN YORDY
Entity type:Individual
Prefix:
First Name:IRVIN
Middle Name:YORDY
Last Name:AGUILERA HERNANDEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:IRVIN
Other - Middle Name:
Other - Last Name:AGUILERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1727 S JACKSON AVE APT 25E
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74107-2016
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2325 S HARVARD AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-3300
Practice Address - Country:US
Practice Address - Phone:918-712-4301
Practice Address - Fax:918-560-1399
Is Sole Proprietor?:No
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator