Provider Demographics
NPI:1134740103
Name:AGUSTIN, JOYCE I (CAREGIVER)
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:I
Last Name:AGUSTIN
Suffix:
Gender:F
Credentials:CAREGIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99-150 HOLO PL
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-5407
Mailing Address - Country:US
Mailing Address - Phone:808-284-2496
Mailing Address - Fax:
Practice Address - Street 1:99-150 HOLO PL
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-5407
Practice Address - Country:US
Practice Address - Phone:808-284-2496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-01
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1-170076OtherCTA/DOH