Provider Demographics
NPI:1740879741
Name:AQUINO, KIMBERLY MARLIX (PT)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARLIX
Last Name:AQUINO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:J4 CALLE 5
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959-2078
Mailing Address - Country:US
Mailing Address - Phone:939-579-2959
Mailing Address - Fax:787-771-1644
Practice Address - Street 1:J4 CALLE 5
Practice Address - Street 2:
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00959-2078
Practice Address - Country:US
Practice Address - Phone:939-579-2959
Practice Address - Fax:787-771-1644
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009142183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician