Basic Information
| Provider Information | |||||||||
| NPI: | 1265149306 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUIRRE | ||||||||
| FirstName: | EDWIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 W AVENUE K # 483 | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935365229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188360885 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45111 FERN AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619491206 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2022 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.