Provider Demographics
NPI:1619467792
Name:AQUINO, SALVADOR (LPC-17281)
Entity Type:Individual
Prefix:
First Name:SALVADOR
Middle Name:
Last Name:AQUINO
Suffix:
Gender:M
Credentials:LPC-17281
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2361
Mailing Address - Country:US
Mailing Address - Phone:760-572-4100
Mailing Address - Fax:
Practice Address - Street 1:401 PICACHO RD
Practice Address - Street 2:
Practice Address - City:WINTERHAVEN
Practice Address - State:CA
Practice Address - Zip Code:92283-9605
Practice Address - Country:US
Practice Address - Phone:760-572-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17281101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional