Provider Demographics
NPI:1962810564
Name:AQUINO, JO-ANN B (RDN)
Entity type:Individual
Prefix:
First Name:JO-ANN
Middle Name:B
Last Name:AQUINO
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9989 PRINCESS CUT ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-6282
Mailing Address - Country:US
Mailing Address - Phone:702-773-0358
Mailing Address - Fax:702-263-9493
Practice Address - Street 1:6900 N PECOS RD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89086-4400
Practice Address - Country:US
Practice Address - Phone:702-773-0358
Practice Address - Fax:702-263-9493
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV39654-DI-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV104100000XMedicaid