Provider Demographics
NPI:1558122366
Name:AQUINO, JUAN R SR
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:R
Last Name:AQUINO
Suffix:SR
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 1:4160 PIEDMONT PKWY STE 111
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-8178
Mailing Address - Country:US
Mailing Address - Phone:336-645-6733
Mailing Address - Fax:
Practice Address - Street 1:840 C STREET
Practice Address - Street 2:111
Practice Address - City:SAN RAEFAL
Practice Address - State:CA
Practice Address - Zip Code:94901
Practice Address - Country:US
Practice Address - Phone:415-259-9126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst