Provider Demographics
NPI:1285652396
Name:AGCAOILI, CARMENCITA (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMENCITA
Middle Name:
Last Name:AGCAOILI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39141 CIVIC CENTER DRIVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-5822
Mailing Address - Country:US
Mailing Address - Phone:510-608-1334
Mailing Address - Fax:510-608-1384
Practice Address - Street 1:2000 MOWRY AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1716
Practice Address - Country:US
Practice Address - Phone:510-797-1111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44473207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A444730OtherBLUE SHIELD OF CA
CA00A444730Medicaid
CA00A444730OtherBLUE SHIELD OF CA
CAE89173Medicare UPIN