Provider Demographics
NPI:1164548350
Name:AGUIRRE, JOAQUIN JR (LAADC)
Entity type:Individual
Prefix:MR
First Name:JOAQUIN
Middle Name:
Last Name:AGUIRRE
Suffix:JR
Gender:M
Credentials:LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21850 BELLEVIEW RD SPC 57
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-9651
Mailing Address - Country:US
Mailing Address - Phone:408-396-8638
Mailing Address - Fax:
Practice Address - Street 1:160 E VIRGINIA ST STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5865
Practice Address - Country:US
Practice Address - Phone:408-287-6200
Practice Address - Fax:408-998-1535
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCI02670315101YA0400X
101YA0400X
CAA8469304101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LCI02670315OtherCALIFORNIA CONSORTIUM OF ADDICTION PROGRAMS AND PROFESSIONALS
CAA8469304OtherCADCII