Provider Demographics
NPI:1699493403
Name:AGUIRRE, PAOLA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11507 VINTAGE PL
Mailing Address - Street 2:
Mailing Address - City:PORTER RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91326-4305
Mailing Address - Country:US
Mailing Address - Phone:818-363-9083
Mailing Address - Fax:
Practice Address - Street 1:9335 RESEDA BLVD STE 101
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2977
Practice Address - Country:US
Practice Address - Phone:818-960-0633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-17
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0018156929OtherKAISER PERMANENTE