Healthcare Provider Details

I. General information

NPI: 1508729120
Provider Name (Legal Business Name): PASCAL RUDAHINDWA BISIMWA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9618 W MOSSYWOOD DR
BOISE ID
83709-5333
US

IV. Provider business mailing address

9618 W MOSSYWOOD DR
BOISE ID
83709-5333
US

V. Phone/Fax

Practice location:
  • Phone: 208-246-9902
  • Fax:
Mailing address:
  • Phone: 208-246-9902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: