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General NPI Number Information
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NPI Number | 1003200957
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Entity Type | Individual
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Provider Name | JASON AGUIRRE M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/27/2015
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Last Update Date | 09/16/2019
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Provider Practice Location Address
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Address Line | 1516 SAWTELLE BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90025
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Country | US
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Telephone | 310-445-5999
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Fax |
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Provider Business Mailing Address
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Address Line | 140 CLUB RD
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City | PASADENA
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State | CA
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Zip | 91105-1412
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Country | US
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Telephone | 626-644-6432
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A156653
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License Number State | CA
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