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General NPI Number Information
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NPI Number | 1861363970
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Entity Type | Individual
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Provider Name | INES KIRUBUSA MULONGO
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Gender | Female
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 6338 N 69TH DR
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City | GLENDALE
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State | AZ
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Zip | 85303-3910
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Country | US
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Telephone | 623-760-8398
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Fax |
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Provider Business Mailing Address
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Address Line | 6338 N 69TH DR
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City | GLENDALE
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State | AZ
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Zip | 85303-3910
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Country | US
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Telephone | 623-760-8398
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Fax |
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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 | 385HR2055X
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Taxonomy Name | Child Mental Illness Respite Care
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License Number | 13255309
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 253J00000X
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Taxonomy Name | Foster Care Agency
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License Number | 13255309
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License Number State | AZ
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