Provider Demographics
NPI:1679367486
Name:AQUINO, JUSIAH MALACHI
Entity type:Individual
Prefix:
First Name:JUSIAH
Middle Name:MALACHI
Last Name:AQUINO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3137 SEACREST AVE APT 9
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-3065
Mailing Address - Country:US
Mailing Address - Phone:831-224-0567
Mailing Address - Fax:
Practice Address - Street 1:3137 SEACREST AVE APT 9
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3065
Practice Address - Country:US
Practice Address - Phone:831-224-0567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst