Healthcare Provider Details

I. General information

NPI: 1225553902
Provider Name (Legal Business Name): CHARLES MARCO AQUILINA PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 W MACARTHUR BLVD
OAKLAND CA
94609-2819
US

IV. Provider business mailing address

380 W MACARTHUR BLVD
OAKLAND CA
94609-2819
US

V. Phone/Fax

Practice location:
  • Phone: 510-251-3917
  • Fax: 510-251-3954
Mailing address:
  • Phone: 510-251-3917
  • Fax: 510-251-3954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY33521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: