Provider Demographics
NPI:1437944089
Name:AGONCILLO, JEFFER
Entity type:Individual
Prefix:
First Name:JEFFER
Middle Name:
Last Name:AGONCILLO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7921 PEACHTREE AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6109
Mailing Address - Country:US
Mailing Address - Phone:818-809-0455
Mailing Address - Fax:
Practice Address - Street 1:7921 PEACHTREE AVE
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-6109
Practice Address - Country:US
Practice Address - Phone:818-809-0455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2278C0205XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, CertifiedCritical Care