Provider Demographics
NPI:1730172081
Name:AGUILAR-SINCABAN, VIRGINIA A (MD)
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:A
Last Name:AGUILAR-SINCABAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 CAPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1215
Mailing Address - Country:US
Mailing Address - Phone:608-230-6168
Mailing Address - Fax:
Practice Address - Street 1:1902 CAPITAL AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1215
Practice Address - Country:US
Practice Address - Phone:608-230-6168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16152-020174400000X
WI161522084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE096609656Medicaid
NE04304OtherBLUE CROSS BLUE SHIELD NE