Provider Demographics
NPI:1619260338
Name:AQUINO, FEDERICO G
Entity Type:Individual
Prefix:MR
First Name:FEDERICO
Middle Name:G
Last Name:AQUINO
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FIDEL
Other - Middle Name:S
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-2661
Mailing Address - Country:US
Mailing Address - Phone:650-218-7167
Mailing Address - Fax:650-756-2200
Practice Address - Street 1:333 GELLERT BLVD
Practice Address - Street 2:131
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-2621
Practice Address - Country:US
Practice Address - Phone:650-218-7167
Practice Address - Fax:650-756-2200
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA6997072343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)