MEDICARE: JIMMY MUYUMBU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	171M00000X	Case Manager/Care Coordinator
2	172A00000X	Driver
3	373H00000X	Day Training/Habilitation Specialist
4	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568190429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY MUYUMBU

Provider Business Mailing Address
First Line	:	10835 N 25TH AVE STE 125
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3461
Country	:	US
Telephone Number	:	520-331-5287
Fax Number	:

Provider Business Practice Location Address
First Line	:	10835 N 25TH AVE STE 125
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85029-3461
Country	:	US
Telephone Number	:	520-331-5287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2022
Last Update Date	:	12/06/2022

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Directions to “ JIMMY MUYUMBU ” Practice Location

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