Provider Demographics
NPI:1184790396
Name:AGUILAR, TRINIDAD (MD)
Entity type:Individual
Prefix:
First Name:TRINIDAD
Middle Name:
Last Name:AGUILAR
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 1:303 S GLENOAKS BLVD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1319
Mailing Address - Country:US
Mailing Address - Phone:818-845-7228
Mailing Address - Fax:818-845-7298
Practice Address - Street 1:303 S GLENOAKS BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1319
Practice Address - Country:US
Practice Address - Phone:818-845-7228
Practice Address - Fax:818-845-7298
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2010-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG079465207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G794650Medicaid
CAG079465OtherSTATE LICENSE NUMBER
CAG10912Medicare UPIN
CAWG79465EMedicare ID - Type UnspecifiedMEDICARE RENDERING MD #