| Lg Aguilar Tabora, Md Inc | |
|
8650 Genessee Ave. Ste 214 #8684 San Diego CA 92192-8684 | |
| (858) 252-8655 | |
| (619) 930-9022 |
| Full Name | Lg Aguilar Tabora, Md Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 8650 Genessee Ave. Ste 214, San Diego, California |
| Authorized Official Name and Position | Lesly Giselle Aguilar Tabora (PRESIDENT) |
| Authorized Official Contact | 8582528655 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lg Aguilar Tabora, Md Inc Po Box 928684 San Diego CA 92192-8684 Ph: (858) 252-8655 | Lg Aguilar Tabora, Md Inc 8650 Genessee Ave. Ste 214 #8684 San Diego CA 92192-8684 Ph: (858) 252-8655 |
| NPI Number | 1225579006 |
|---|---|
| Provider Enumeration Date | 03/14/2017 |
| Last Update Date | 12/28/2017 |
| Medicare PECOS PAC ID | 3375814700 |
|---|---|
| Medicare Enrollment ID | O20170803002215 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225579006 | NPI | - | NPPES |
| PENDING | Other | CA | PENDING MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | A106980 (California) | Primary |
| Provider Name | Lesly Giselle Aguilar Tabora |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1467638601 PECOS PAC ID: 1759450984 Enrollment ID: I20120601000485 |
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