Provider Demographics
NPI:1578450623
Name:AGUIRRE, SERGIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 POWELL DR
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92377-5912
Mailing Address - Country:US
Mailing Address - Phone:909-838-1356
Mailing Address - Fax:
Practice Address - Street 1:1809 W REDLANDS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-8054
Practice Address - Country:US
Practice Address - Phone:909-335-3026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-20
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95035672363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health