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Organization

LG AGUILAR TABORA, MD INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. LESLY GISELLE AGUILAR TABORA M.D. (PRESIDENT)
(858) 252-8655
Entity
Organization

Contact information

Practice address
8650 GENESSEE AVE. STE 214, #8684, SAN DIEGO, CA 92192-8684
(858) 252-8655
(619) 930-9022
Mailing address
PO BOX 928684, SAN DIEGO, CA 92192-8684
(858) 252-8655
(619) 930-9022

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
A106980
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PENDING
PENDING MEDICARE
CA
Enumeration date
03/14/2017
Last updated
12/28/2017
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