Provider Demographics
NPI:1720835689
Name:AGUIRRE, MARIO JOSE JR
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:JOSE
Last Name:AGUIRRE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:MARIO
Other - Middle Name:JOSE
Other - Last Name:AGUIRRE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MARIO J AGUIRRE
Mailing Address - Street 1:14320 PALM DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-6874
Mailing Address - Country:US
Mailing Address - Phone:760-863-8258
Mailing Address - Fax:
Practice Address - Street 1:14320 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-6874
Practice Address - Country:US
Practice Address - Phone:760-863-8258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator