Provider Demographics
NPI:1508923772
Name:FELIX, AGNES (PHD)
Entity Type:Individual
Prefix:DR
First Name:AGNES
Middle Name:
Last Name:FELIX
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2224
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-0224
Mailing Address - Country:US
Mailing Address - Phone:808-382-6816
Mailing Address - Fax:
Practice Address - Street 1:91-1001 KAIMALIE ST
Practice Address - Street 2:SUITE 201-B
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-6247
Practice Address - Country:US
Practice Address - Phone:808-382-6816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPSY-883103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI569634Medicaid
HI100476Medicare ID - Type Unspecified