Provider Demographics
NPI:1376815639
Name:AGOSTO, KRYSIA MAY KU'UIPOLANI (PCT,)
Entity type:Individual
Prefix:MRS
First Name:KRYSIA
Middle Name:MAY KU'UIPOLANI
Last Name:AGOSTO
Suffix:
Gender:F
Credentials:PCT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 EILEEN ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89115-0146
Mailing Address - Country:US
Mailing Address - Phone:702-772-0192
Mailing Address - Fax:
Practice Address - Street 1:87-128 LILIANA ST
Practice Address - Street 2:
Practice Address - City:WAIANAE
Practice Address - State:HI
Practice Address - Zip Code:96792-3142
Practice Address - Country:US
Practice Address - Phone:808-953-9532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner