Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A156653 | CA |
NPI | 1003200957 |
---|---|
Provider Name | Jason Aguirre |
First Address | Pasadena, CA 91105-1412 |
Second Address | Los Angeles, CA 90025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2015 |
Last Update Date | 16/09/2019 |