Healthcare Provider Details

I. General information

NPI: 1003051533
Provider Name (Legal Business Name): RONNY AQUININ MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2008
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10093 BAY HARBOR TERRACE
BAY HARBOR ISLANDS FL
33154-1509
US

IV. Provider business mailing address

10093 BAY HARBOR TERRACE
BAY HARBOR ISLANDS FL
33154-1509
US

V. Phone/Fax

Practice location:
  • Phone: 305-495-1052
  • Fax:
Mailing address:
  • Phone: 305-495-1052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME98088
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME98088
License Number StateFL

VIII. Authorized Official

Name: RONNY AQUININ
Title or Position: PRESIDENT/PHYSICIAN
Credential: M.D.
Phone: 305-495-1052