Provider Demographics
NPI:1225603186
Name:AQUINO, TITO PICASSO
Entity Type:Individual
Prefix:
First Name:TITO
Middle Name:PICASSO
Last Name:AQUINO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22415 SE 231ST ST STE B103
Mailing Address - Street 2:
Mailing Address - City:MAPLE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98038-5002
Mailing Address - Country:US
Mailing Address - Phone:425-906-4300
Mailing Address - Fax:
Practice Address - Street 1:22415 SE 231ST ST STE B103
Practice Address - Street 2:
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-5002
Practice Address - Country:US
Practice Address - Phone:425-906-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst