Healthcare Provider Details

I. General information

NPI: 1669950713
Provider Name (Legal Business Name): ALEXIS ROXANNE AGUIRRE OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6180 BROCKTON AVE STE 102
RIVERSIDE CA
92506-2259
US

IV. Provider business mailing address

6180 BROCKTON AVE STE 102
RIVERSIDE CA
92506-2259
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-6500
  • Fax:
Mailing address:
  • Phone: 951-684-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number18888
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: