Provider Demographics
NPI:1639948201
Name:AGCAOILI, SCARLETT (RN)
Entity Type:Individual
Prefix:
First Name:SCARLETT
Middle Name:
Last Name:AGCAOILI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:SCARLETT
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6130 CAMINO REAL SPC 213
Mailing Address - Street 2:
Mailing Address - City:JURUPA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92509-8213
Mailing Address - Country:US
Mailing Address - Phone:909-645-2278
Mailing Address - Fax:
Practice Address - Street 1:6130 CAMINO REAL SPC 213
Practice Address - Street 2:
Practice Address - City:JURUPA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92509-8213
Practice Address - Country:US
Practice Address - Phone:909-645-2278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95228951163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse