Provider Demographics
NPI:1053154153
Name:CABUAL, AGNES CELIA
Entity type:Individual
Prefix:
First Name:AGNES CELIA
Middle Name:
Last Name:CABUAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3340 TOPAZ ST STE 270
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-3907
Mailing Address - Country:US
Mailing Address - Phone:225-573-7646
Mailing Address - Fax:
Practice Address - Street 1:3340 S. TOPAZ ROAD
Practice Address - Street 2:#270
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121
Practice Address - Country:US
Practice Address - Phone:225-573-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1582-PCS-0374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide