Basic Information
| Provider Information | |||||||||
| NPI: | 1700475167 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AQUINO | ||||||||
| FirstName: | ISABELLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25330 SILVER ASPEN WAY APT 524 | ||||||||
| Address2: | |||||||||
| City: | VALENCIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913810717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156889921 | ||||||||
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| Practice Location | |||||||||
| Address1: | 45111 FERN AVE | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619491206 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2021 | ||||||||
| LastUpdateDate: | 01/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | CA | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.