Provider Demographics
NPI:1912881061
Name:AGCAOILI, LAURENCE JACOB DE GUZMAN
Entity type:Individual
Prefix:
First Name:LAURENCE JACOB
Middle Name:DE GUZMAN
Last Name:AGCAOILI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9716 WATERMAN RD
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-4012
Mailing Address - Country:US
Mailing Address - Phone:279-257-0449
Mailing Address - Fax:
Practice Address - Street 1:9716 WATERMAN RD
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-4012
Practice Address - Country:US
Practice Address - Phone:279-257-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-02
Last Update Date:2025-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician