Provider Demographics
NPI:1407489883
Name:AGUIRRE, JESSICA MARIA
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MARIA
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 1:1028 BATCHLER RD
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-5412
Mailing Address - Country:US
Mailing Address - Phone:972-992-8680
Mailing Address - Fax:
Practice Address - Street 1:1028 BATCHLER RD
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-5412
Practice Address - Country:US
Practice Address - Phone:972-992-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-13
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX845159210Medicaid