Healthcare Provider Details

I. General information

NPI: 1588850440
Provider Name (Legal Business Name): JOHN JOSEPH AGUIRRE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHN JOSEPH WEIS AGUIRRE

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 08/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NW A ST
ANTLERS OK
74523-2215
US

IV. Provider business mailing address

210 NW A ST
ANTLERS OK
74523-2215
US

V. Phone/Fax

Practice location:
  • Phone: 580-513-0739
  • Fax:
Mailing address:
  • Phone: 580-513-0739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: