Provider Demographics
NPI:1104051846
Name:AQUINO, SERWYNA DELOS SANTOS (PT)
Entity type:Individual
Prefix:
First Name:SERWYNA
Middle Name:DELOS SANTOS
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA SERWYNA
Other - Middle Name:DELOS SANTOS
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:24630 WASHINGTON AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-6177
Mailing Address - Country:US
Mailing Address - Phone:951-696-9353
Mailing Address - Fax:951-973-7216
Practice Address - Street 1:28780 SINGLE OAK DR
Practice Address - Street 2:SUITE 290
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-3625
Practice Address - Country:US
Practice Address - Phone:951-693-5871
Practice Address - Fax:951-693-5872
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 35666225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0249754OtherWA STATE DEPT OF LABOR
CA0PT356660OtherBLUE SHIELD
CA0249754OtherWA STATE DEPT OF LABOR