Provider Demographics
NPI:1770162661
Name:DEAQUINO, ALMA ROSA
Entity type:Individual
Prefix:
First Name:ALMA
Middle Name:ROSA
Last Name:DEAQUINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9175 DATE ST APT D
Mailing Address - Street 2:
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-5657
Mailing Address - Country:US
Mailing Address - Phone:909-434-5000
Mailing Address - Fax:
Practice Address - Street 1:9175 DATE ST APT D
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-5657
Practice Address - Country:US
Practice Address - Phone:909-434-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD2291819343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)