Provider Demographics
NPI:1154579134
Name:ASUQUO, ASUQUO EDET (LVN)
Entity type:Individual
Prefix:MR
First Name:ASUQUO
Middle Name:EDET
Last Name:ASUQUO
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E HIGHLAND AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4646
Mailing Address - Country:US
Mailing Address - Phone:909-881-1100
Mailing Address - Fax:909-881-1100
Practice Address - Street 1:1200 E HIGHLAND AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4646
Practice Address - Country:US
Practice Address - Phone:909-881-1100
Practice Address - Fax:909-881-1100
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6444620001Medicare NSC