Healthcare Provider Details

I. General information

NPI: 1730568940
Provider Name (Legal Business Name): TASHINGA MUSONZA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2015
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

1 BAYLOR PLZ STE 404D
HOUSTON TX
77030-3411
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8040
  • Fax: 719-776-6820
Mailing address:
  • Phone: 713-798-8629
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberDR.0064293
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10052961
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0064293
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: