Provider Demographics
NPI:1073679700
Name:AQUINO, JOSE ALFREDO SR (MA)
Entity Type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALFREDO
Last Name:AQUINO
Suffix:SR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 486
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970-0486
Mailing Address - Country:US
Mailing Address - Phone:787-235-9030
Mailing Address - Fax:787-287-3509
Practice Address - Street 1:140 AVE LAS CUMBRES STE 201
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-5527
Practice Address - Country:US
Practice Address - Phone:787-235-9030
Practice Address - Fax:782-287-3509
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2018-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1772103T00000X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR2039178OtherCIGNA
PR734OtherHUMANA HEALTHPLANS
PR149867OtherFHC HEALTHSYSTEMS
PR5720OtherFIRST MEDICAL
PR2039178OtherCIGNA
PR734OtherHUMANA HEALTHPLANS