Provider Demographics
NPI:1609193218
Name:AQUINO, GRACE PALISOC
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:PALISOC
Last Name:AQUINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:VELASQUEZ
Other - Last Name:PALISOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE
Mailing Address - Street 1:10117 CAREFREE DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-1802
Mailing Address - Country:US
Mailing Address - Phone:858-231-4494
Mailing Address - Fax:
Practice Address - Street 1:655 PARK CENTER DR
Practice Address - Street 2:
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-6957
Practice Address - Country:US
Practice Address - Phone:619-596-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA728616163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse