Provider Demographics
NPI:1255996658
Name:EYONG, AGNES KIMA (CNS)
Entity type:Individual
Prefix:MS
First Name:AGNES
Middle Name:KIMA
Last Name:EYONG
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:AGNES
Other - Middle Name:KIMA
Other - Last Name:EYONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:181 LADY BELL WAY
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2996
Mailing Address - Country:US
Mailing Address - Phone:562-419-5050
Mailing Address - Fax:
Practice Address - Street 1:8990 GARFIELD ST STE 6
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3922
Practice Address - Country:US
Practice Address - Phone:562-419-5050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022015363LF0000X
CA815089163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily