Healthcare Provider Details

I. General information

NPI: 1053777110
Provider Name (Legal Business Name): LEA AQUINO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2016
Last Update Date: 01/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 E VERNON ST
LONG BEACH CA
90806-2727
US

IV. Provider business mailing address

724 E VERNON ST
LONG BEACH CA
90806-2727
US

V. Phone/Fax

Practice location:
  • Phone: 562-881-8184
  • Fax:
Mailing address:
  • Phone: 562-881-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number329217
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: