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General NPI Number Information
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NPI Number | 1699008300
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Entity Type | Individual
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Provider Name | USMAN JAWA BUNDU REGISTERED NURSE
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Gender | Male
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Dates
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Enumeration Date | 09/13/2009
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Last Update Date | 09/13/2009
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Provider Practice Location Address
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Address Line | 18224 N 168TH AVE
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City | SURPRISE
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State | AZ
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Zip | 85374-6868
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Country | US
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Telephone | 602-918-0408
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Fax | 623-444-6989
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Provider Business Mailing Address
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Address Line | 18224 N 168TH AVE
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City | SURPRISE
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State | AZ
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Zip | 85374-6868
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Country | US
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Telephone | 602-918-0408
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Fax | 623-444-6989
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | BH-3442
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License Number State | AZ
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