Provider Demographics
NPI:1790827731
Name:AGUIRRE, PETRA
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:
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 1:631 S BROOKHURST ST UNIT 104
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3510
Mailing Address - Country:US
Mailing Address - Phone:714-620-8131
Mailing Address - Fax:714-620-8132
Practice Address - Street 1:631 S BROOKHURST ST UNIT 104
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3510
Practice Address - Country:US
Practice Address - Phone:714-620-8131
Practice Address - Fax:714-620-8132
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)