Provider Demographics
NPI:1649831967
Name:AGUIRRE, SOFIA
Entity type:Individual
Prefix:MISS
First Name:SOFIA
Middle Name:
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 1:15333 SAN PEDRO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-3719
Mailing Address - Country:US
Mailing Address - Phone:210-979-0244
Mailing Address - Fax:210-979-0249
Practice Address - Street 1:510 E RAMSEY RD STE 5
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-4658
Practice Address - Country:US
Practice Address - Phone:210-979-0244
Practice Address - Fax:210-979-0249
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106S00000X106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician