Healthcare Provider Details

I. General information

NPI: 1093076416
Provider Name (Legal Business Name): LARRY AGUIRRE II PA-C, DMSC, CAQ-PSY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2012
Last Update Date: 09/02/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 S ORCHARD AVE STE A
UKIAH CA
95482-5022
US

IV. Provider business mailing address

PO BOX 1449
UKIAH CA
95482-1449
US

V. Phone/Fax

Practice location:
  • Phone: 707-472-0350
  • Fax: 707-472-0358
Mailing address:
  • Phone: 707-472-6453
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21850
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: