Provider Demographics
NPI:1831462886
Name:AQUINO, BERTHA ALICIA (RASI)
Entity Type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:ALICIA
Last Name:AQUINO
Suffix:
Gender:F
Credentials:RASI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5244 WOOD AVE
Mailing Address - Street 2:C
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-5365
Mailing Address - Country:US
Mailing Address - Phone:323-245-2035
Mailing Address - Fax:
Practice Address - Street 1:5244 WOOD AVE
Practice Address - Street 2:# C
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-5365
Practice Address - Country:US
Practice Address - Phone:323-245-2035
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARI-A1201191404101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)