Provider Demographics
NPI:1760268692
Name:AGUIRRE, SARAH ELAINE
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:ELAINE
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELAINE
Other - Last Name:SEERATTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:150 S. HUNTINGTON AVE
Mailing Address - Street 2:SW 122 CSP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:760-458-1099
Mailing Address - Fax:
Practice Address - Street 1:150 S. HUNTINGTON AVE
Practice Address - Street 2:SW 122 CSP
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130
Practice Address - Country:US
Practice Address - Phone:760-458-1099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RICSW03381261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA