Healthcare Provider Details

I. General information

NPI: 1568015923
Provider Name (Legal Business Name): RUMBIDZAI MUTIKANI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2019
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 N CIVIC SQ STE 220
GOODYEAR AZ
85395-2391
US

IV. Provider business mailing address

1800 N CIVIC SQ STE 220
GOODYEAR AZ
85395-2391
US

V. Phone/Fax

Practice location:
  • Phone: 623-474-8370
  • Fax: 623-474-8380
Mailing address:
  • Phone: 623-474-8370
  • Fax: 623-474-8380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number77682
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: