Healthcare Provider Details

I. General information

NPI: 1154311694
Provider Name (Legal Business Name): SUZANNE LEI AQUINO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 LUMAHAI ST
HONOLULU HI
96825-2104
US

IV. Provider business mailing address

4040 E CAMELBACK RD STE 250
PHOENIX AZ
85018-8350
US

V. Phone/Fax

Practice location:
  • Phone: 208-416-2932
  • Fax: 855-673-9190
Mailing address:
  • Phone: 855-687-7237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101241898
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberT2815
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD-14328
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: