Healthcare Provider Details

I. General information

NPI: 1932034394
Provider Name (Legal Business Name): BERTILDE UWIZEYE KAMANA PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 SEA RIDGE RD APT 4
APTOS CA
95003-4337
US

IV. Provider business mailing address

349 SEA RIDGE RD APT 4
APTOS CA
95003-4337
US

V. Phone/Fax

Practice location:
  • Phone: 616-802-4687
  • Fax:
Mailing address:
  • Phone: 616-802-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-26964
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: