Provider Demographics
NPI:1740050012
Name:AQUINO, JOANNE COLLANTES (PA-C)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:COLLANTES
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 S LA CIENEGA BLVD PH 13
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2054
Mailing Address - Country:US
Mailing Address - Phone:310-749-3772
Mailing Address - Fax:
Practice Address - Street 1:2421 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-2301
Practice Address - Country:US
Practice Address - Phone:310-320-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA64824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program