=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831467570
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RAY E. AQUITANIA, M.D. INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2011
-----------------------------------------------------
Last Update Date | 12/08/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8881 FLETCHER PKWY SUITE 235
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-667-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8881 FLETCHER PKWY SUITE 235
-----------------------------------------------------
City | LA MESA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91942-3134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-667-2700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | MR. RAMONCITO E AQUITANIA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 619-667-2700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | G70129
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------