Kimberly Corpuz-Agbalog Clark, LVN

Primary specialty

Licensed Vocational NurseTaxonomy code 164X00000X

License

250826 Issued in CA

Practice address

1825 E Thelborn St
West Covina, CA 91791-1442

Phone

(626) 915-3844

NPI assigned

Jun 23, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kimberly Corpuz Agbalog Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1624406400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1033788187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14410 MULBERRY DR APT 113",
            "city": "WHITTIER",
            "state": "CA",
            "postal_code": "906041398",
            "telephone_number": "562-673-3176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 E THELBORN ST",
            "city": "WEST COVINA",
            "state": "CA",
            "postal_code": "917911442",
            "telephone_number": "626-915-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "KIMBERLY",
        "middle_name": "CORPUZ-AGBALOG",
        "credential": "LVN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-23",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164X00000X",
            "taxonomy_group": "",
            "desc": "Licensed Vocational Nurse",
            "state": "CA",
            "license": "250826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "AGBALOG",
            "middle_name": "CORPUZ",
            "credential": "LVN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Licensed Vocational Nurse in West Covina, CA
• Providers in West Covina, CA by specialty
• Licensed Vocational Nurse in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.