Provider Demographics
NPI:1508064148
Name:AGOSTO, JANEEN MAHEALANI (MED)
Entity Type:Individual
Prefix:MRS
First Name:JANEEN
Middle Name:MAHEALANI
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85-880 IMIPONO ST
Mailing Address - Street 2:
Mailing Address - City:WAIANAE
Mailing Address - State:HI
Mailing Address - Zip Code:96792-2681
Mailing Address - Country:US
Mailing Address - Phone:808-772-9481
Mailing Address - Fax:808-696-9987
Practice Address - Street 1:85-880 IMIPONO ST
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-2681
Practice Address - Country:US
Practice Address - Phone:808-772-9481
Practice Address - Fax:808-696-9987
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor