Basic Information
| Provider Information | |||||||||
| NPI: | 1659969574 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AGUILAR | ||||||||
| FirstName: | ISAAC | ||||||||
| MiddleName: | CUAUHCOATL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2701 N 12TH ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984067316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3238397150 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3315 S 23RD ST STE 210 | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984051616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2535728684 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2021 | ||||||||
| LastUpdateDate: | 01/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | 61092959 | WA | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.