Provider Demographics
NPI:1679799167
Name:AGUIRRE, BERENICE D
Entity type:Individual
Prefix:MISS
First Name:BERENICE
Middle Name:D
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 1:83699 HOPI AVE
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-2678
Mailing Address - Country:US
Mailing Address - Phone:760-347-7784
Mailing Address - Fax:
Practice Address - Street 1:83699 HOPI AVE
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-2678
Practice Address - Country:US
Practice Address - Phone:760-347-7784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program