Provider Demographics
NPI:1407061948
Name:AQUINO, ELOISA P (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELOISA
Middle Name:P
Last Name:AQUINO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3119 GLENDALE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1805
Mailing Address - Country:US
Mailing Address - Phone:323-660-5186
Mailing Address - Fax:323-660-3798
Practice Address - Street 1:3119 GLENDALE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1805
Practice Address - Country:US
Practice Address - Phone:323-660-5186
Practice Address - Fax:323-660-3798
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist