Jacqueline G. Agcaoili, Md Corporation | |
4440 Brockton Ave Suite 320 Riverside CA 92501-4068 | |
(951) 369-6191 | |
(951) 369-0304 |
Full Name | Jacqueline G. Agcaoili, Md Corporation |
---|---|
Speciality | Internal Medicine |
Location | 4440 Brockton Ave, Riverside, California |
Authorized Official Name and Position | Jacqueline Gesner Agcaoili (PRESIDENT) |
Authorized Official Contact | 9513696191 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Jacqueline G. Agcaoili, Md Corporation 4440 Brockton Ave Suite 320 Riverside CA 92501-4068 Ph: (951) 369-6191 | Jacqueline G. Agcaoili, Md Corporation 4440 Brockton Ave Suite 320 Riverside CA 92501-4068 Ph: (951) 369-6191 |
NPI Number | 1639212574 |
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Provider Enumeration Date | 02/14/2007 |
Last Update Date | 01/29/2015 |
Medicare PECOS PAC ID | 7517039373 |
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Medicare Enrollment ID | O20080710000619 |
Identifier | Type | State | Issuer |
---|---|---|---|
1639212574 | NPI | - | NPPES |
00A462310 | Medicaid | CA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | A46231 (California) | Primary |
Provider Name | Jacqueline Agcaoili |
---|---|
Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1124022108 PECOS PAC ID: 4082783824 Enrollment ID: I20080710000615 |
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