Provider Demographics
NPI:1194160143
Name:AGUIRRE, SAMANTHA (SLP)
Entity type:Individual
Prefix:MS
First Name:SAMANTHA
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 S INDIAN HILL BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5461
Mailing Address - Country:US
Mailing Address - Phone:909-451-8521
Mailing Address - Fax:
Practice Address - Street 1:630 S INDIAN HILL BLVD STE 5
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-5461
Practice Address - Country:US
Practice Address - Phone:909-451-8521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASPA17892355S0801X
CASP24550235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant