Provider Demographics
NPI:1730216003
Name:AGUILAR, MARIO R (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:R
Last Name:AGUILAR
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 1:1240 S TELSHOR BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-4731
Mailing Address - Country:US
Mailing Address - Phone:505-522-1212
Mailing Address - Fax:505-522-2898
Practice Address - Street 1:1240 S TELSHOR BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-4731
Practice Address - Country:US
Practice Address - Phone:505-522-1212
Practice Address - Fax:505-522-2898
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-2174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM35154Medicaid
NM35154Medicaid
NMD43004Medicare UPIN