Provider Demographics
NPI:1053660993
Name:AGUIRRE, GUSTAVO DAVID (VMD, PHD)
Entity Type:Individual
Prefix:DR
First Name:GUSTAVO
Middle Name:DAVID
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:VMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6419 OVERBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19151-2414
Mailing Address - Country:US
Mailing Address - Phone:215-879-2757
Mailing Address - Fax:
Practice Address - Street 1:6419 OVERBROOK AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2414
Practice Address - Country:US
Practice Address - Phone:215-879-2757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABV003839L174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0140565OtherVETERINARIAN