Provider Demographics
NPI:1932531829
Name:AQUINO, GUILLERMO (RT(T))
Entity Type:Individual
Prefix:
First Name:GUILLERMO
Middle Name:
Last Name:AQUINO
Suffix:
Gender:M
Credentials:RT(T)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8115 E GALE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9406
Mailing Address - Country:US
Mailing Address - Phone:928-772-0524
Mailing Address - Fax:
Practice Address - Street 1:8115 E GALE RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9406
Practice Address - Country:US
Practice Address - Phone:928-772-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-02
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCTT-10992471R0002X
CARHT001013742471R0002X
OH88675192471R0002X
OR2062152471R0002X
WART 000084082471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy