1760588925 NPI number — MARY FELICITY T. AQUINO D.M.D.

Table of content: MARY FELICITY T. AQUINO D.M.D. (NPI 1760588925)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760588925 NPI number — MARY FELICITY T. AQUINO D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AQUINO
Provider First Name:
MARY FELICITY
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760588925
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
647 VALLEY SPRINGS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91789-4134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-271-0128
Provider Business Mailing Address Fax Number:
626-369-3844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
119 N 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA PUENTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91744-4711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-369-7373
Provider Business Practice Location Address Fax Number:
626-369-3844
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  45085 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 45085 . This is a "SOUTHWEST ADMIN." identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "THE GUARDIAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "DENTAL HEALTH SERVICES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "DELTA DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "HELLER & ASSOCIATES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "S. CA IBEW-NECA TRUST" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "SAFEGUARD PPO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "METLIFE DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "CIGNA DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "SOUTHWEST CARPENTERS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "PRINCIPAL PLAN DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 458085 . This is a "GREATWEST HEALTHCARE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B45085-01 . This is a "DELTA DENTAL HEALTHY FAMI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "HARRINGTON BENEFITS SERVI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 45085 . This is a "AETNA DENTAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: B45085-01 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: FHC70768F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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