Individual
MR. FIDELITO BOADO AGCAOILI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4000 14TH STREET, STE. 208, RIVERSIDE, CA 92501-4136
(951) 369-6191
(951) 369-0304
Mailing address
4000 14TH STREET, STE. 208, RIVERSIDE, CA 92501-4136
(951) 369-6191
(951) 369-0304
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-18803
CA
Other
Enumeration date
07/21/2011
Last updated
07/21/2011
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