=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003051533
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RONNY AQUININ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2008
-----------------------------------------------------
Last Update Date | 05/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10093 BAY HARBOR TERRACE
-----------------------------------------------------
City | BAY HARBOR ISLANDS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-495-1052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10093 BAY HARBOR TERRACE
-----------------------------------------------------
City | BAY HARBOR ISLANDS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33154-1509
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-495-1052
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/PHYSICIAN
-----------------------------------------------------
Name | RONNY AQUININ
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 305-495-1052
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME98088
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME98088
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------