Provider Demographics
NPI:1093347981
Name:BUSOGI, VALENTINE MUKAHIRWA
Entity Type:Individual
Prefix:
First Name:VALENTINE
Middle Name:MUKAHIRWA
Last Name:BUSOGI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3259 E LAFAYETTE AVE
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9074
Mailing Address - Country:US
Mailing Address - Phone:469-486-1889
Mailing Address - Fax:
Practice Address - Street 1:358 E JAVELINA AVE STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85210-6205
Practice Address - Country:US
Practice Address - Phone:877-931-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-07
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144742363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty