Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 1223P0700X | TX |
NPI | 1235593351 |
---|---|
Provider Name | Eugenio Aquino |
First Address | Los Angeles, CA 90005-2553 |
Second Address | Los Angeles, CA 90005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2016 |
Last Update Date | 06/04/2016 |