Healthcare Provider Details

I. General information

NPI: 1033190970
Provider Name (Legal Business Name): MELINDA LUZ AQUINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 12/17/2019
Certification Date: 12/17/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 HAYES ST STE 612
SAN FRANCISCO CA
94117-1078
US

IV. Provider business mailing address

PO BOX 590455
SAN FRANCISCO CA
94159-0455
US

V. Phone/Fax

Practice location:
  • Phone: 415-752-1122
  • Fax: 415-744-1199
Mailing address:
  • Phone: 650-991-1122
  • Fax: 415-744-1199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberA94731
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: