Healthcare Provider Details

I. General information

NPI: 1548618432
Provider Name (Legal Business Name): DOUGLAS EDUARDO AGUIRRE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1202 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3926
US

IV. Provider business mailing address

1202 MARTIN LUTHER KING JR WAY
TACOMA WA
98405-3926
US

V. Phone/Fax

Practice location:
  • Phone: 253-441-4742
  • Fax: 253-441-8680
Mailing address:
  • Phone: 253-441-4742
  • Fax: 253-441-8680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60810745
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60810745
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: