Healthcare Provider Details

I. General information

NPI: 1083003867
Provider Name (Legal Business Name): ELIZABETH AGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2015
Last Update Date: 11/29/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE
LOS ANGELES CA
90015-3070
US

IV. Provider business mailing address

1513 S GRAND AVE
LOS ANGELES CA
90015-3070
US

V. Phone/Fax

Practice location:
  • Phone: 213-747-5542
  • Fax: 213-342-3431
Mailing address:
  • Phone: 626-536-9017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: