Healthcare Provider Details

I. General information

NPI: 1134384779
Provider Name (Legal Business Name): FEMA BALDONADO AQUINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 W WARM SPRINGS RD
LAS VEGAS NV
89113-3612
US

IV. Provider business mailing address

PO BOX 33269
PHOENIX AZ
85067-3269
US

V. Phone/Fax

Practice location:
  • Phone: 24-928-5927
  • Fax: 702-492-8045
Mailing address:
  • Phone: 602-406-4786
  • Fax: 916-636-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number15472
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number15472
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: