Provider Demographics
NPI:1346431145
Name:AGAS, EDILBERTO LUMELAY JR (MD)
Entity type:Individual
Prefix:DR
First Name:EDILBERTO
Middle Name:LUMELAY
Last Name:AGAS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:6926 BROCKTON AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3800
Mailing Address - Country:US
Mailing Address - Phone:951-779-1670
Mailing Address - Fax:951-779-1670
Practice Address - Street 1:6926 BROCKTON AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3800
Practice Address - Country:US
Practice Address - Phone:951-779-1670
Practice Address - Fax:951-779-1670
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2013-01-10
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Provider Licenses
StateLicense IDTaxonomies
CAA100860208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA100860OtherSTATE LICENSE