Individual provider · NPI-1

Jacqueline Gesner Agcaoili, MD

Internal Medicine · Riverside, CA

NPI number1124022108
StatusActive
Last updated in NPPESMar 11, 2020

Details

NPI
1124022108
Entity type
Individual (NPI-1)
Name
Jacqueline Gesner Agcaoili
Credential
MD
Sex
Female
Sole proprietor
Yes
Enumeration date
Jun 8, 2005
Certification date
Mar 11, 2020
Last updated
Mar 11, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207R00000X Internal MedicineA46231CAYes

Practice location

4440 Brockton Ave.
Suite 320
Riverside, CA 92501

Phone 951-369-6191 · Fax 951-369-0304

Mailing address

Po Box 507
Riverside, CA 92501

Phone 951-369-6191 · Fax 951-369-0304

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