Provider Demographics
NPI:1013126549
Name:AGUIRRE, MARIO ESTEBAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ESTEBAN
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3444 KEARNY VILLA RD STE 404
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1963
Mailing Address - Country:US
Mailing Address - Phone:858-495-0355
Mailing Address - Fax:858-495-0058
Practice Address - Street 1:3444 KEARNY VILLA RD STE 404
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1963
Practice Address - Country:US
Practice Address - Phone:858-495-0355
Practice Address - Fax:858-495-0058
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15100363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant