1154311694 NPI number — DR. SUZANNE LEI AQUINO MD

Table of content: DR. JOSEPH E NOONAN JR. M.D. (NPI 1144391921)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154311694 NPI number — DR. SUZANNE LEI AQUINO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AQUINO
Provider First Name:
SUZANNE
Provider Middle Name:
LEI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1154311694
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4040 E CAMELBACK RD STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85018-8350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-687-7237
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 LUMAHAI ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONOLULU
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96825-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-416-2932
Provider Business Practice Location Address Fax Number:
855-673-9190
Provider Enumeration Date:
10/26/2005

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: 2085R0202X , with the licence number:  0101241898 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: T2815 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: MD-14328 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102084165 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1154311694 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21673300 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J18775 . This is a "BCBS MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P00432958 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2833312 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3427944000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 155766 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7100028710 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3177971 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50017690 . This is a "PASSPORT" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: P0043258 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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