Provider Demographics
NPI:1780666115
Name:AQUINO, EDITHA MENDOZA (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDITHA
Middle Name:MENDOZA
Last Name:AQUINO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SPRINGS RD.
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-5713
Mailing Address - Country:US
Mailing Address - Phone:707-642-3711
Mailing Address - Fax:707-556-9237
Practice Address - Street 1:2600 SPRINGS RD
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-5713
Practice Address - Country:US
Practice Address - Phone:707-642-3711
Practice Address - Fax:707-556-9237
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0330571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB33057-01OtherMEDI-CAL PROVIDER NUMBER