Provider Demographics
NPI:1356852156
Name:PIERCE-AQUINO, LISA ELIZABETH
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ELIZABETH
Last Name:PIERCE-AQUINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13355 FERN HOLLOW WAY
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92392-0408
Mailing Address - Country:US
Mailing Address - Phone:760-792-7427
Mailing Address - Fax:
Practice Address - Street 1:15770 MOJAVE DR STE L
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-1934
Practice Address - Country:US
Practice Address - Phone:760-843-7809
Practice Address - Fax:760-843-7810
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)