Healthcare Provider Details

I. General information

NPI: 1528880218
Provider Name (Legal Business Name): KRISTEN AGUIRRE, MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25200 LA PAZ RD STE 210
LAGUNA HILLS CA
92653-5137
US

IV. Provider business mailing address

1208 VISTA CAYENTA
SAN CLEMENTE CA
92672-2356
US

V. Phone/Fax

Practice location:
  • Phone: 949-306-5853
  • Fax: 954-516-0928
Mailing address:
  • Phone: 949-306-5853
  • Fax: 954-516-0928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KRISTEN AGUIRRE
Title or Position: OWNER
Credential: MD
Phone: 949-306-5853