Provider Demographics
NPI:1609491158
Name:AQUINO, KAITLIN (PA-C)
Entity Type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E ANAHEIM ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3550
Mailing Address - Country:US
Mailing Address - Phone:562-591-0840
Mailing Address - Fax:562-591-4181
Practice Address - Street 1:855 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3550
Practice Address - Country:US
Practice Address - Phone:562-591-0840
Practice Address - Fax:562-591-4181
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-10
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant