Healthcare Provider Details

I. General information

NPI: 1972334357
Provider Name (Legal Business Name): RUVIMBO MUTONGI-MUSIWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2024
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5055 E BROADWAY BLVD UNIT 221
TUCSON AZ
85711-3640
US

IV. Provider business mailing address

5055 E BROADWAY BLVD UNIT 221
TUCSON AZ
85711-3640
US

V. Phone/Fax

Practice location:
  • Phone: 520-244-6745
  • Fax:
Mailing address:
  • Phone: 520-244-6745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number223288
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: