Provider Demographics
NPI:1376986869
Name:AGUIRREGAVIRIA, ANN M
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:AGUIRREGAVIRIA
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 1:10850 S US HIGHWAY 1 STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6407
Mailing Address - Country:US
Mailing Address - Phone:772-463-0444
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:10850 S US HIGHWAY 1 STE 2
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6407
Practice Address - Country:US
Practice Address - Phone:772-463-0444
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-15
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-10-3982103K00000X
106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior AnalystGroup - Multi-Specialty