Healthcare Provider Details

I. General information

NPI: 1265775035
Provider Name (Legal Business Name): ANDREA AGCAOILI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2013
Last Update Date: 11/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 TREAT BLVD
WALNUT CREEK CA
94597
US

IV. Provider business mailing address

1450 TREAT BLVD
WALNUT CREEK CA
94597
US

V. Phone/Fax

Practice location:
  • Phone: 925-296-9720
  • Fax: 925-296-9030
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberSL1012
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A14672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: