Basic Information
Provider Information
NPI: 1609151083
EntityType: 2
ReplacementNPI:  
OrganizationName: SAMUEL AGUIRRE
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 760 HARRISON ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941071235
CountryCode: US
TelephoneNumber: 4158361700
FaxNumber: 4158361737
Practice Location
Address1: 760 HARRISON ST
Address2:  
City: SAN FRANCISCO
State: CA
PostalCode: 941071235
CountryCode: US
TelephoneNumber: 4158361700
FaxNumber: 4158361737
Other Information
ProviderEnumerationDate: 10/17/2011
LastUpdateDate: 02/03/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: AGUIRRE
AuthorizedOfficialFirstName: SAMUEL
AuthorizedOfficialMiddleName: MASANGKAY
AuthorizedOfficialTitleorPosition: 2585-HEALTH WORKER 1
AuthorizedOfficialTelephone: 4158361700
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y193400000X SINGLE SPECIALTY GROUPBehavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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