MEDICARE: STEPHANIE MARIE AGUIRRE

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	324500000X	Substance Abuse Rehabilitation Facility		CA

General Provider Information

NPI Number	:	1912645078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE AGUIRRE

Provider Business Mailing Address
First Line	:	2644 30TH ST STE 100
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3051
Country	:	US
Telephone Number	:	310-314-6200
Fax Number	:	310-450-2024

Provider Business Practice Location Address
First Line	:	2644 30TH ST
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90405-3060
Country	:	US
Telephone Number	:	310-314-6200
Fax Number	:

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

Provider Enumeration Date	:	05/26/2022
Last Update Date	:	05/26/2022

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Directions to “ STEPHANIE MARIE AGUIRRE ” Practice Location

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