Provider Demographics
NPI:1033815980
Name:AGUIRRE CALLIRGOS, GIOVANNI MIGUEL (PA-C)
Entity Type:Individual
Prefix:
First Name:GIOVANNI
Middle Name:MIGUEL
Last Name:AGUIRRE CALLIRGOS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6669 S DANIEL WAY
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-6521
Mailing Address - Country:US
Mailing Address - Phone:801-915-8554
Mailing Address - Fax:
Practice Address - Street 1:6669 S DANIEL WAY
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84123-6521
Practice Address - Country:US
Practice Address - Phone:801-915-8554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13234382-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant