Provider Demographics
NPI:1861804056
Name:AGUILO RODRIGUEZ, LOURDES XIOMARA (MD)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:XIOMARA
Last Name:AGUILO RODRIGUEZ
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:PO BOX 607
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-0607
Mailing Address - Country:US
Mailing Address - Phone:787-247-7420
Mailing Address - Fax:
Practice Address - Street 1:1130 E 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4034
Practice Address - Country:US
Practice Address - Phone:417-347-2273
Practice Address - Fax:417-347-2277
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29957207Q00000X, 207Q00000X
MO2015036883207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine