MEDICARE: FABIAN 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	103TC0700X	Clinical Psychologist	34850	TX

General Provider Information

NPI Number	:	1972261311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FABIAN AGUIRRE

Provider Business Mailing Address
First Line	:	5454 LA SIERRA DR STE 201
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2344
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5454 LA SIERRA DR STE 201
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-2344
Country	:	US
Telephone Number	:	888-923-2256
Fax Number	:

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

Provider Enumeration Date	:	12/02/2021
Last Update Date	:	12/02/2021

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Directions to “ FABIAN AGUIRRE ” Practice Location

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