Healthcare Provider Details

I. General information

NPI: 1871837013
Provider Name (Legal Business Name): GIRLIE AQUINO UY DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2012
Last Update Date: 11/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9867 MAGNOLIA AVE STE E
RIVERSIDE CA
92503-3519
US

IV. Provider business mailing address

9867 MAGNOLIA AVE STE E
RIVERSIDE CA
92503-3519
US

V. Phone/Fax

Practice location:
  • Phone: 951-352-2112
  • Fax: 951-352-2088
Mailing address:
  • Phone: 951-352-2112
  • Fax: 951-352-2088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number56967
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code305S00000X
TaxonomyPoint of Service
License Number56967
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number56967
License Number StateCA

VIII. Authorized Official

Name: DR. GIRLIE AQUINO UY
Title or Position: PRESIDENT
Credential: DDS
Phone: 951-352-2112