Provider Demographics
NPI:1053869701
Name:AGUILAR, SUSAN ILEANA
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:ILEANA
Last Name:AGUILAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N DIXIE ST
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:OK
Mailing Address - Zip Code:73550-2405
Mailing Address - Country:US
Mailing Address - Phone:580-318-7584
Mailing Address - Fax:
Practice Address - Street 1:727 N DIXIE ST
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:OK
Practice Address - Zip Code:73550-2405
Practice Address - Country:US
Practice Address - Phone:580-318-7584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist