Healthcare Provider Details

I. General information

NPI: 1700475167
Provider Name (Legal Business Name): ISABELLA AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 05/27/2025
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

393 E WALNUT ST
PASADENA CA
91188-2301
US

IV. Provider business mailing address

25330 SILVER ASPEN WAY APT 524
VALENCIA CA
91381-0717
US

V. Phone/Fax

Practice location:
  • Phone: 833-511-0106
  • Fax:
Mailing address:
  • Phone: 415-688-9921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: