Provider Demographics
NPI:1326450511
Name:AQUINO-VITALITY MEDICAL GROUP
Entity Type:Organization
Organization Name:AQUINO-VITALITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:702-457-3888
Mailing Address - Street 1:3365 E FLAMINGO RD
Mailing Address - Street 2:STE 2
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-6800
Mailing Address - Country:US
Mailing Address - Phone:702-457-3888
Mailing Address - Fax:702-974-2199
Practice Address - Street 1:3365 E FLAMINGO RD
Practice Address - Street 2:STE 2
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-6800
Practice Address - Country:US
Practice Address - Phone:702-457-3888
Practice Address - Fax:702-974-2199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV001166363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty