Healthcare Provider Details

I. General information

NPI: 1871782441
Provider Name (Legal Business Name): BRADLEY J. AGUIRRE D.P.M.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 VERDUGO BLVD SUITE 303
GLENDALE CA
91208-9976
US

IV. Provider business mailing address

1818 VERDUGO BLVD SUITE 303
GLENDALE CA
91208-9976
US

V. Phone/Fax

Practice location:
  • Phone: 818-248-2454
  • Fax: 818-248-8503
Mailing address:
  • Phone: 818-248-2454
  • Fax: 818-248-8503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3310
License Number StateCA

VIII. Authorized Official

Name: DR. BRADLEY J AGUIRRE
Title or Position: OWNER
Credential: DPM
Phone: 818-248-2454