Provider Demographics
NPI:1588775480
Name:AGUIRRE, BRADLEY JAY (DPM)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAY
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1818 VERDUGO BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-9976
Mailing Address - Country:US
Mailing Address - Phone:818-952-2600
Mailing Address - Fax:818-952-2666
Practice Address - Street 1:1818 VERDUGO BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-9976
Practice Address - Country:US
Practice Address - Phone:818-248-2454
Practice Address - Fax:818-248-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3310213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE33100Medicaid
CAE33100Medicaid
CAE3310Medicare ID - Type Unspecified