Provider Demographics
NPI:1518521780
Name:AGONOY, LEA F
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:F
Last Name:AGONOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-968 WAIHUA PL
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-1866
Mailing Address - Country:US
Mailing Address - Phone:808-304-7607
Mailing Address - Fax:
Practice Address - Street 1:91-968 WAIHUA PL
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-1866
Practice Address - Country:US
Practice Address - Phone:808-304-7607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-23
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI75018163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool