Provider Demographics
NPI:1841842499
Name:AQUILINA, JENNIFER R (DIPLAC LAC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:R
Last Name:AQUILINA
Suffix:
Gender:F
Credentials:DIPLAC LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5762
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85010-5762
Mailing Address - Country:US
Mailing Address - Phone:480-881-0044
Mailing Address - Fax:
Practice Address - Street 1:7520 E CAMELBACK RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-3511
Practice Address - Country:US
Practice Address - Phone:602-957-2602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-14
Last Update Date:2019-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010055171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist