Provider Demographics
NPI:1225316466
Name:AGCAOILI, FIDELITO BOADO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FIDELITO
Middle Name:BOADO
Last Name:AGCAOILI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4000 14TH STREET
Mailing Address - Street 2:STE. 208
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-4136
Mailing Address - Country:US
Mailing Address - Phone:951-369-6191
Mailing Address - Fax:951-369-0304
Practice Address - Street 1:4000 14TH STREET
Practice Address - Street 2:STE. 208
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-4136
Practice Address - Country:US
Practice Address - Phone:951-369-6191
Practice Address - Fax:951-369-0304
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-18803363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant