Healthcare Provider Details

I. General information

NPI: 1700291150
Provider Name (Legal Business Name): RAFAEL TOLENTINO AQUINO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 FAIRFAX AVE STE 610
NORFOLK VA
23507-1912
US

IV. Provider business mailing address

825 FAIRFAX AVE STE 610
NORFOLK VA
23507-1914
US

V. Phone/Fax

Practice location:
  • Phone: 757-446-8960
  • Fax: 757-446-5197
Mailing address:
  • Phone: 757-446-8960
  • Fax: 757-446-5197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101284247
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number328449
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number0101284247
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: