MEDICARE: NANCY JEANETTE AGUIRRE FNP-C

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
1	363L00000X	Nurse Practitioner	95009622	CA

General Provider Information

NPI Number	:	1356826994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY JEANETTE AGUIRRE FNP-C

Provider Business Mailing Address
First Line	:	981 W ARROW HWY
Second Line	:
City	:	SAN DIMAS
State	:	CA
Zip	:	91773-2410
Country	:	US
Telephone Number	:	323-737-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1655 S WESTERN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90006-5801
Country	:	US
Telephone Number	:	323-715-8230
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2018
Last Update Date	:	07/19/2023

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