Provider Demographics
NPI:1942071204
Name:AGUIRRE, ELYSIA MARIAH
Entity Type:Individual
Prefix:MISS
First Name:ELYSIA
Middle Name:MARIAH
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 1:111 N GILBERT RD APT 2111
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-0952
Mailing Address - Country:US
Mailing Address - Phone:520-252-2946
Mailing Address - Fax:
Practice Address - Street 1:111 N GILBERT RD APT 2111
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-0952
Practice Address - Country:US
Practice Address - Phone:480-397-2071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst