Provider Demographics
NPI: | 1164548350 |
---|---|
Name: | AGUIRRE, JOAQUIN JR (LAADC) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | JOAQUIN |
Middle Name: | |
Last Name: | AGUIRRE |
Suffix: | JR |
Gender: | M |
Credentials: | LAADC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 21850 BELLEVIEW RD SPC 57 |
Mailing Address - Street 2: | |
Mailing Address - City: | SONORA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 95370-9651 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 408-396-8638 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 160 E VIRGINIA ST STE 100 |
Practice Address - Street 2: | |
Practice Address - City: | SAN JOSE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 95112-5865 |
Practice Address - Country: | US |
Practice Address - Phone: | 408-287-6200 |
Practice Address - Fax: | 408-998-1535 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2007-03-21 |
Last Update Date: | 2022-05-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | LCI02670315 | 101YA0400X |
101YA0400X | ||
CA | A8469304 | 101YA0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
LCI02670315 | Other | CALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS | |
CA | A8469304 | Other | CADCII |