Healthcare Provider Details

I. General information

NPI: 1952821704
Provider Name (Legal Business Name): CHRISTINA AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7417 N 67TH DR
GLENDALE AZ
85303-2133
US

IV. Provider business mailing address

6537 N 55TH AVE UNIT 533
GLENDALE AZ
85311-7923
US

V. Phone/Fax

Practice location:
  • Phone: 480-430-8724
  • Fax:
Mailing address:
  • Phone: 480-430-8724
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA999997202
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: