Provider Demographics
NPI:1851172886
Name:AGNGARAYNGAY, KATHRINA (CNA)
Entity Type:Individual
Prefix:
First Name:KATHRINA
Middle Name:
Last Name:AGNGARAYNGAY
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-132 POOHUKU WAY
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-5808
Mailing Address - Country:US
Mailing Address - Phone:808-393-9032
Mailing Address - Fax:808-200-4118
Practice Address - Street 1:94-132 POOHUKU WAY
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-5808
Practice Address - Country:US
Practice Address - Phone:808-393-9032
Practice Address - Fax:808-200-4118
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-05
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-230064311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility