Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003152927 |
---|---|
Provider Name | Marixa Aguirre |
First Address | Lake Elsinore, CA 92530-4400 |
Second Address | Lake Elsinore, CA 92530-4400 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2012 |
Last Update Date | 20/12/2012 |