Provider Demographics
NPI:1962048488
Name:AQUINO, MELLANY ANN (PNP)
Entity type:Individual
Prefix:
First Name:MELLANY
Middle Name:ANN
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:MELLANY
Other - Middle Name:
Other - Last Name:GLINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:290 PACIFICA DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1394
Mailing Address - Country:US
Mailing Address - Phone:650-455-1562
Mailing Address - Fax:
Practice Address - Street 1:3100 SUMMIT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3412
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013266363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics