Provider Demographics
NPI:1013920065
Name:AGUIRRE, NAN RUFFYN (PHD)
Entity Type:Individual
Prefix:
First Name:NAN
Middle Name:RUFFYN
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 E NAPLES PLZ
Mailing Address - Street 2:STE 308
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803-5091
Mailing Address - Country:US
Mailing Address - Phone:562-277-1337
Mailing Address - Fax:562-344-5446
Practice Address - Street 1:5855 E NAPLES PLZ
Practice Address - Street 2:STE 308
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-5091
Practice Address - Country:US
Practice Address - Phone:562-277-1337
Practice Address - Fax:562-344-5446
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17979103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL 17979 0OtherBLUE SHIELD
CA6958240Medicaid
CA6958240Medicaid