Provider Demographics
NPI:1689028342
Name:AGOJO, HAYDEELYN
Entity Type:Individual
Prefix:
First Name:HAYDEELYN
Middle Name:
Last Name:AGOJO
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 1:6855 W CHARLESTON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-1675
Mailing Address - Country:US
Mailing Address - Phone:702-241-2050
Mailing Address - Fax:702-241-2051
Practice Address - Street 1:6855 W CHARLESTON BLVD STE B
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1675
Practice Address - Country:US
Practice Address - Phone:702-241-2050
Practice Address - Fax:702-241-2051
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVG63-02022376J00000X, 372500000X, 372600000X, 374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker
No372500000XNursing Service Related ProvidersChore Provider
No372600000XNursing Service Related ProvidersAdult Companion