Healthcare Provider Details

I. General information

NPI: 1912667825
Provider Name (Legal Business Name): ERIKA FABIOLA AGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21738 US HIGHWAY 18
APPLE VALLEY CA
92307-3916
US

IV. Provider business mailing address

4237 NOYER LN
JURUPA VALLEY CA
92509-6678
US

V. Phone/Fax

Practice location:
  • Phone: 760-247-1840
  • Fax:
Mailing address:
  • Phone: 951-536-7732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberTCH154279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: