Healthcare Provider Details

I. General information

NPI: 1992656177
Provider Name (Legal Business Name): MATTHEW VINCE AGUIRRE PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W 4TH ST STE 206
SAN BERNARDINO CA
92401-1438
US

IV. Provider business mailing address

570 W 4TH ST STE 206
SAN BERNARDINO CA
92401-1438
US

V. Phone/Fax

Practice location:
  • Phone: 760-260-8602
  • Fax:
Mailing address:
  • Phone: 760-260-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95041226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: