Provider Demographics
NPI:1679948848
Name:AGUIAR, KYLE (CHA-III)
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:AGUIAR
Suffix:
Gender:M
Credentials:CHA-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1008
Mailing Address - Street 2:
Mailing Address - City:KOKHANOK
Mailing Address - State:AK
Mailing Address - Zip Code:99606
Mailing Address - Country:US
Mailing Address - Phone:907-282-2203
Mailing Address - Fax:907-282-2240
Practice Address - Street 1:1 AIRPORT RD.
Practice Address - Street 2:
Practice Address - City:KOKHANOK
Practice Address - State:AK
Practice Address - Zip Code:99606
Practice Address - Country:US
Practice Address - Phone:907-282-2203
Practice Address - Fax:907-282-2240
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker