Provider Demographics
NPI:1376435933
Name:AGUIRRE, IMELDA FELICYA
Entity type:Individual
Prefix:
First Name:IMELDA
Middle Name:FELICYA
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1126 W FOOTHILL BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-3786
Mailing Address - Country:US
Mailing Address - Phone:909-982-8641
Mailing Address - Fax:
Practice Address - Street 1:8863 SAN BERNARDINO RD
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-2321
Practice Address - Country:US
Practice Address - Phone:909-910-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171400000X171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach