Basic Information
| Provider Information | |||||||||
| NPI: | 1669575874 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AGUIRRE-CARLOS | ||||||||
| FirstName: | MYRA | ||||||||
| MiddleName: | LUNTOK | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | AGUIRRE | ||||||||
| OtherFirstName: | MYRA | ||||||||
| OtherMiddleName: | LUNTOK | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1700 N WATERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924045115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098838611 | ||||||||
| FaxNumber: | 9098815707 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 N WATERMAN AVE | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924045115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098838611 | ||||||||
| FaxNumber: | 9098815707 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2006 | ||||||||
| LastUpdateDate: | 07/02/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | T2005018390 | MO | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | A104621 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.