Healthcare Provider Details

I. General information

NPI: 1104772763
Provider Name (Legal Business Name): JULIET BAVUGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2026
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3933 E EDNA AVE
PHOENIX AZ
85032-2127
US

IV. Provider business mailing address

3933 E EDNA AVE
PHOENIX AZ
85032-2127
US

V. Phone/Fax

Practice location:
  • Phone: 650-420-9888
  • Fax:
Mailing address:
  • Phone: 650-420-9888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN331412
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: