Healthcare Provider Details

I. General information

NPI: 1750217626
Provider Name (Legal Business Name): MARIBETH P AQUINO TCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 BROADWAY
MILLBRAE CA
94030-1909
US

IV. Provider business mailing address

615 BROADWAY
MILLBRAE CA
94030-1909
US

V. Phone/Fax

Practice location:
  • Phone: 650-697-0166
  • Fax:
Mailing address:
  • Phone: 650-697-0166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number200358
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: