Provider Demographics
NPI:1407330350
Name:AGUIRRE, MARIA PETRA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:PETRA
Last Name:AGUIRRE
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 1:3607 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79903-4410
Mailing Address - Country:US
Mailing Address - Phone:915-355-1641
Mailing Address - Fax:915-566-2282
Practice Address - Street 1:3607 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79903-4410
Practice Address - Country:US
Practice Address - Phone:915-355-1641
Practice Address - Fax:915-566-2282
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX149565310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility