Provider Demographics
NPI:1841379856
Name:AQUINO, MADELAINE MABUNGA (MD)
Entity Type:Individual
Prefix:DR
First Name:MADELAINE
Middle Name:MABUNGA
Last Name:AQUINO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:10200 TRINITY PKWY
Mailing Address - Street 2:SUITE 207
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7286
Mailing Address - Country:US
Mailing Address - Phone:209-943-6740
Mailing Address - Fax:209-943-6744
Practice Address - Street 1:10200 TRINITY PKWY
Practice Address - Street 2:SUITE 207
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7286
Practice Address - Country:US
Practice Address - Phone:209-943-6740
Practice Address - Fax:209-943-6744
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2013-04-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA85500208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
H08949Medicare UPIN