Healthcare Provider Details

I. General information

NPI: 1639299647
Provider Name (Legal Business Name): AURELIO TONY AGUIRRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2007
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 S OLIVE ST
LOS ANGELES CA
90015-3023
US

IV. Provider business mailing address

1936 E ANAHEIM ST
LONG BEACH CA
90813-3908
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax: 213-746-9379
Mailing address:
  • Phone: 562-599-2248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15565
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA15565
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberPA15565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: