Provider Demographics
NPI:1801276357
Name:AGUERO, PETER IV
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:AGUERO
Suffix:IV
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:PETER
Other - Middle Name:DAVID
Other - Last Name:AGUERO
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:4 PASEO AZUCENO
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-2893
Mailing Address - Country:US
Mailing Address - Phone:949-456-0067
Mailing Address - Fax:
Practice Address - Street 1:18210 YORBA LINDA BLVD STE 404
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-4060
Practice Address - Country:US
Practice Address - Phone:714-646-8010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-30
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86268106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist