Provider Demographics
NPI:1447246863
Name:AGUILAR, EDGAR CASTRO (OD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:CASTRO
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 W ATEN RD
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251-9718
Mailing Address - Country:US
Mailing Address - Phone:760-352-3505
Mailing Address - Fax:760-545-0186
Practice Address - Street 1:506 W ATEN RD
Practice Address - Street 2:
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251-9718
Practice Address - Country:US
Practice Address - Phone:760-352-3505
Practice Address - Fax:760-545-0186
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-21
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 12273T174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV02562Medicare UPIN
CAWY210Medicare ID - Type Unspecified
CAWOP12273AMedicare ID - Type Unspecified