Provider Demographics
NPI:1518188366
Name:MADELAINE AQUINO, M.D. INC.
Entity Type:Organization
Organization Name:MADELAINE AQUINO, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELAINE
Authorized Official - Middle Name:MABUNGA
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-943-6740
Mailing Address - Street 1:10200 TRINITY PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7286
Mailing Address - Country:US
Mailing Address - Phone:209-943-6740
Mailing Address - Fax:209-943-6744
Practice Address - Street 1:10200 TRINITY PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7286
Practice Address - Country:US
Practice Address - Phone:209-943-6740
Practice Address - Fax:209-943-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA07-00087928261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center