Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 38332 | TX |
Y | 103T00000X | Psychologist | 38332 | TX |
NPI | 1013556059 |
---|---|
Provider Name | Dr. Luis Eduardo Aguerrevere |
First Address | Lufkin, TX 75904-3193 |
Second Address | Lufkin, TX 75904-3193 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2019 |
Last Update Date | 21/12/2019 |