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NPI Code Detail

MEDICARE: DR. LARRY AGUIRRE II PA-C, DMSC, CAQ-PSY

MEDICARE: DR. LARRY AGUIRRE II PA-C, DMSC, CAQ-PSY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA21850CA
2363A00000XPhysician AssistantPA21850CA

General Provider Information

NPI Number : 1093076416
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LARRY AGUIRRE II PA-C, DMSC, CAQ-PSY
Provider Business Mailing Address
First Line : PO BOX 1449
Second Line :
City : UKIAH
State : CA
Zip : 95482-1449
Country : US
Telephone Number : 707-472-6453
Fax Number :
Provider Business Practice Location Address
First Line : 531 S ORCHARD AVE STE A
Second Line :
City : UKIAH
State : CA
Zip : 95482-5022
Country : US
Telephone Number : 707-472-0350
Fax Number : 707-472-0358
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2012
Last Update Date : 09/02/2025

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