Provider Demographics
NPI:1174760458
Name:AGUILAR, ESEL (CBHCMS/FMD/BS)
Entity type:Individual
Prefix:
First Name:ESEL
Middle Name:
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:CBHCMS/FMD/BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-5265
Mailing Address - Country:US
Mailing Address - Phone:786-975-7485
Mailing Address - Fax:
Practice Address - Street 1:12001 SW 128TH CT STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4665
Practice Address - Country:US
Practice Address - Phone:954-860-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014082100Medicaid
FLCBHCMS100118OtherFLORIDA CERTIFICATION BOARD