Provider Demographics
NPI:1144042060
Name:AGUIRRE, JESUS YAHEL
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:YAHEL
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 1:874 S MAIN ST UNIT 6665
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS
Mailing Address - State:AZ
Mailing Address - Zip Code:85349-7371
Mailing Address - Country:US
Mailing Address - Phone:928-388-9793
Mailing Address - Fax:
Practice Address - Street 1:791 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3067
Practice Address - Country:US
Practice Address - Phone:928-920-6220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician