Provider Demographics
NPI:1740469659
Name:AQUINO, MARIE (PA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:CUETO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2741 VISTA WAY
Mailing Address - Street 2:SUITE 111
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6372
Mailing Address - Country:US
Mailing Address - Phone:760-757-0222
Mailing Address - Fax:760-757-0224
Practice Address - Street 1:2741 VISTA WAY
Practice Address - Street 2:SUITE 111
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6372
Practice Address - Country:US
Practice Address - Phone:760-757-0222
Practice Address - Fax:760-757-0224
Is Sole Proprietor?:No
Enumeration Date:2007-10-26
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16179363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant