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NPI Code Detail

MEDICARE: MARTIN BONIFACE GITOBU MUTONGA

MEDICARE: MARTIN BONIFACE GITOBU MUTONGA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085N0700XNeuroradiology Physician345108LA
22085R0204XVascular & Interventional Radiology Physician345108LA
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1043675028
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN BONIFACE GITOBU MUTONGA
Provider Business Mailing Address
First Line : 1514 JEFFERSON HWY
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70121-2429
Country : US
Telephone Number : 504-842-4000
Fax Number :
Provider Business Practice Location Address
First Line : 1514 JEFFERSON HWY
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70121-2429
Country : US
Telephone Number : 504-842-3470
Fax Number : 504-842-7372
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2015
Last Update Date : 02/18/2026

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Directions to “ MARTIN BONIFACE GITOBU MUTONGA ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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