Provider Demographics
NPI:1093076416
Name:AGUIRRE, LARRY II (PA-C, DMSC, CAQ-PSY)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:
Last Name:AGUIRRE
Suffix:II
Gender:M
Credentials:PA-C, DMSC, CAQ-PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 E GOBBI ST STE B
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5511
Mailing Address - Country:US
Mailing Address - Phone:707-472-6453
Mailing Address - Fax:
Practice Address - Street 1:350 E GOBBI ST STE B
Practice Address - Street 2:
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5511
Practice Address - Country:US
Practice Address - Phone:707-472-6453
Practice Address - Fax:707-472-0358
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21850363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical