Healthcare Provider Details

I. General information

NPI: 1700300258
Provider Name (Legal Business Name): JENNIFER AGUIRRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 11/12/2025
Certification Date:
Deactivation Date: 05/05/2025
Reactivation Date: 11/12/2025

III. Provider practice location address

5740 RALSTON ST STE 100
VENTURA CA
93003-7847
US

IV. Provider business mailing address

7428 BAIRD AVE
RESEDA CA
91335-2814
US

V. Phone/Fax

Practice location:
  • Phone: 805-289-3100
  • Fax:
Mailing address:
  • Phone: 818-943-0335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: