Healthcare Provider Details

I. General information

NPI: 1558558098
Provider Name (Legal Business Name): HILARY AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2007
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 MARENGO ST SECOND 2ND FLOOR
LOS ANGELES CA
90033-1317
US

IV. Provider business mailing address

8334 DAVIS ST
DOWNEY CA
90241-4919
US

V. Phone/Fax

Practice location:
  • Phone: 323-276-6450
  • Fax:
Mailing address:
  • Phone: 562-965-4434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: