Healthcare Provider Details

I. General information

NPI: 1942077029
Provider Name (Legal Business Name): JAQUELIN AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5190 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

IV. Provider business mailing address

5190 ATLANTIC AVE
LONG BEACH CA
90805-6510
US

V. Phone/Fax

Practice location:
  • Phone: 562-428-4111
  • Fax:
Mailing address:
  • Phone: 310-304-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT163556
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: