Provider Demographics
NPI:1992043558
Name:AQUINO, ROMMEL SANTOS (PTA)
Entity Type:Individual
Prefix:MR
First Name:ROMMEL
Middle Name:SANTOS
Last Name:AQUINO
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 GREENBANK AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-1438
Mailing Address - Country:US
Mailing Address - Phone:626-825-2802
Mailing Address - Fax:
Practice Address - Street 1:558 GREENBANK AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1438
Practice Address - Country:US
Practice Address - Phone:626-825-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5882225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant