Provider Demographics
NPI:1871782441
Name:BRADLEY J. AGUIRRE D.P.M.,P.C.
Entity type:Organization
Organization Name:BRADLEY J. AGUIRRE D.P.M.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGUIRRE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-248-2454
Mailing Address - Street 1:1818 VERDUGO BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-9976
Mailing Address - Country:US
Mailing Address - Phone:818-248-2454
Mailing Address - Fax:818-248-8503
Practice Address - Street 1:1818 VERDUGO BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-9976
Practice Address - Country:US
Practice Address - Phone:818-248-2454
Practice Address - Fax:818-248-8503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3310213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21581Medicare PIN
CA4726160001Medicare NSC