Healthcare Provider Details

I. General information

NPI: 1578450623
Provider Name (Legal Business Name): SERGIO AGUIRRE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1809 W REDLANDS BLVD STE 103
REDLANDS CA
92373-8054
US

IV. Provider business mailing address

2331 POWELL DR
RIALTO CA
92377-5912
US

V. Phone/Fax

Practice location:
  • Phone: 909-335-3026
  • Fax:
Mailing address:
  • Phone: 909-838-1356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95035672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: