Provider Demographics
NPI:1902108954
Name:UTRERA, DAN AGUILA
Entity Type:Individual
Prefix:
First Name:DAN
Middle Name:AGUILA
Last Name:UTRERA
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 1:1835 E GUADALUPE RD
Mailing Address - Street 2:#103
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-3277
Mailing Address - Country:US
Mailing Address - Phone:480-456-0942
Mailing Address - Fax:
Practice Address - Street 1:290 S COOPER RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-5897
Practice Address - Country:US
Practice Address - Phone:480-812-7167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-24
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT 10168106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist