Provider Demographics
NPI:1144045147
Name:AGUIRRE, CARMEN YAJAIRA (MA, CF-SLP)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:YAJAIRA
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:MA, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1096 JADE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9568
Mailing Address - Country:US
Mailing Address - Phone:915-549-5854
Mailing Address - Fax:
Practice Address - Street 1:4950 MCNUTT RD
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88008-9621
Practice Address - Country:US
Practice Address - Phone:575-882-6200
Practice Address - Fax:575-882-2508
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSAH-2024-0398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist