Provider Demographics
NPI:1427235027
Name:AQUINO, SUSAN G (NP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:G
Last Name:AQUINO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:DEGUZMAN
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2630 POINTER DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-3561
Mailing Address - Country:US
Mailing Address - Phone:909-595-6272
Mailing Address - Fax:
Practice Address - Street 1:1177 N PARK AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3028
Practice Address - Country:US
Practice Address - Phone:909-623-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17932363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology