Provider Demographics
NPI:1013466853
Name:AGONIAS, EVANGELINE (ETC)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:
Last Name:AGONIAS
Suffix:
Gender:F
Credentials:ETC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-1135 AWALAI ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3234
Mailing Address - Country:US
Mailing Address - Phone:808-726-7378
Mailing Address - Fax:808-367-1413
Practice Address - Street 1:94-1135 AWALAI ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3234
Practice Address - Country:US
Practice Address - Phone:808-726-7378
Practice Address - Fax:808-367-1413
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor