Healthcare Provider Details

I. General information

NPI: 1740446475
Provider Name (Legal Business Name): AMY LYNN DAGUIO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4646 BROCKTON AVE STE 203
RIVERSIDE CA
92506-0173
US

IV. Provider business mailing address

4646 BROCKTON AVE STE 203
RIVERSIDE CA
92506-0173
US

V. Phone/Fax

Practice location:
  • Phone: 951-788-8332
  • Fax: 951-788-2880
Mailing address:
  • Phone: 951-788-8332
  • Fax: 951-788-2880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMY LYNN MARQUEZ DAGUIO
Title or Position: OWNER
Credential: M.D.
Phone: 951-403-9575