Provider Demographics
NPI:1922775444
Name:AGUIRRE, KRYSTAL RAE (ASW 118001)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:RAE
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:ASW 118001
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7493
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93031-7493
Mailing Address - Country:US
Mailing Address - Phone:805-775-7303
Mailing Address - Fax:
Practice Address - Street 1:2130 N VENTURA RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-2246
Practice Address - Country:US
Practice Address - Phone:805-289-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA118001104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker