Provider Demographics
NPI:1407691546
Name:DE AQUINO, JONATHAN BALDWIN LADIA
Entity type:Individual
Prefix:MR
First Name:JONATHAN BALDWIN
Middle Name:LADIA
Last Name:DE AQUINO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JONATHAN
Other - Middle Name:LADIA
Other - Last Name:DE AQUINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:225 N CALVERT ST APT 1431
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-4959
Mailing Address - Country:US
Mailing Address - Phone:650-892-9716
Mailing Address - Fax:
Practice Address - Street 1:225 N CALVERT ST APT 1431
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-4959
Practice Address - Country:US
Practice Address - Phone:650-892-9716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-29
Last Update Date:2024-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR253841163WC0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine