Provider Demographics
NPI:1790650596
Name:PROBY, AIDEE GUADALUPE
Entity type:Individual
Prefix:
First Name:AIDEE
Middle Name:GUADALUPE
Last Name:PROBY
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 1:177 W SOUTH ST APT 114
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-6460
Mailing Address - Country:US
Mailing Address - Phone:323-272-3875
Mailing Address - Fax:
Practice Address - Street 1:1408 S REDONDO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4136
Practice Address - Country:US
Practice Address - Phone:909-232-5532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-09
Last Update Date:2025-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies