Provider Demographics
NPI:1912472614
Name:AQUINO, BENBENEDIC MONTOYA (RCSN)
Entity type:Individual
Prefix:
First Name:BENBENEDIC
Middle Name:MONTOYA
Last Name:AQUINO
Suffix:
Gender:M
Credentials:RCSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2095 PARALTA AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-3424
Mailing Address - Country:US
Mailing Address - Phone:956-639-2290
Mailing Address - Fax:
Practice Address - Street 1:2095
Practice Address - Street 2:2095 PARALTA AVENUE
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955
Practice Address - Country:US
Practice Address - Phone:956-639-2290
Practice Address - Fax:831-796-7036
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA180206474163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool