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

Table of content: NATALIE KILPATRICK MA (NPI 1134733173)

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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