Healthcare Provider Details

I. General information

NPI: 1487445904
Provider Name (Legal Business Name): JENNIFER AQUINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/14/2025
Certification Date: 05/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2109 OTOOLE AVE STE M
SAN JOSE CA
95131-1338
US

IV. Provider business mailing address

25888 GADING RD APT 2
HAYWARD CA
94544-2755
US

V. Phone/Fax

Practice location:
  • Phone: 408-573-7720
  • Fax:
Mailing address:
  • Phone: 650-278-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number7311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: