Evangeline Agoncillo
Individual provider Active NPI Homemaker · Las Vegas, NV
NPI 1164063475 · NPPES record last updated Oct 8, 2019
Key facts
- NPI
- 1164063475
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Homemaker 376J00000X
- Practice address
- 4850 W Flamingo Rd
Las Vegas, NV 89103-3705 - Phone
- (702) 871-9917
- NPI assigned
- Oct 8, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Homemaker | 376J00000X | Yes |
Addresses
Primary practice location
4850 W Flamingo Rd
Las Vegas, NV 89103-3705
Mailing address
9235 Marlia St
Las Vegas, NV 89123-3710
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 8, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.