Provider Demographics
NPI:1881032811
Name:AGUIRRE, ROBERTO GEORGE JR (MA)
Entity Type:Individual
Prefix:MR
First Name:ROBERTO
Middle Name:GEORGE
Last Name:AGUIRRE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:GEORGE
Other - Last Name:AGUIRRE
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:6305 WOODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2346
Mailing Address - Country:US
Mailing Address - Phone:818-908-4999
Mailing Address - Fax:
Practice Address - Street 1:6305 WOODMAN AVE
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2346
Practice Address - Country:US
Practice Address - Phone:818-908-4999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109770106H00000X
225400000X
CAMFTI80641106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner