Provider Demographics
NPI:1760212658
Name:AVAKIAN, ANAISE AQUINO (PNP-PC)
Entity type:Individual
Prefix:
First Name:ANAISE
Middle Name:AQUINO
Last Name:AVAKIAN
Suffix:
Gender:
Credentials:PNP-PC
Other - Prefix:
Other - First Name:ANAISE
Other - Middle Name:
Other - Last Name:AQUINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PNP-PC
Mailing Address - Street 1:3020 CHILDREN'S WAY MC5003
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92132-4223
Mailing Address - Country:US
Mailing Address - Phone:858-309-6300
Mailing Address - Fax:
Practice Address - Street 1:3020 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4223
Practice Address - Country:US
Practice Address - Phone:858-966-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95028667363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics