MEDICARE: JOANNE COLLANTES AQUINO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant	64824	CA

General Provider Information

NPI Number	:	1740050012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNE COLLANTES AQUINO PA-C

Provider Business Mailing Address
First Line	:	7001 S LA CIENEGA BLVD PH 13
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2054
Country	:	US
Telephone Number	:	310-749-3772
Fax Number	:

Provider Business Practice Location Address
First Line	:	15031 RINALDI ST
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91345-1207
Country	:	US
Telephone Number	:	818-365-8051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2024
Last Update Date	:	06/04/2026

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