Healthcare Provider Details

I. General information

NPI: 1982423380
Provider Name (Legal Business Name): KELLY NICOLE AGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N OAKLAND AVE
PASADENA CA
91101-1714
US

IV. Provider business mailing address

180 N OAKLAND AVE
PASADENA CA
91101-1714
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-5556
  • Fax: 626-584-5558
Mailing address:
  • Phone: 626-584-5556
  • Fax: 626-584-5558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number93109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: