Provider Demographics
NPI:1235136854
Name:NYAMUSWA, GILBERT MUDIWA (MD)
Entity Type:Individual
Prefix:DR
First Name:GILBERT
Middle Name:MUDIWA
Last Name:NYAMUSWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18000 STUDEBAKER RD STE 800
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2671
Mailing Address - Country:US
Mailing Address - Phone:562-735-3226
Mailing Address - Fax:
Practice Address - Street 1:10001 S EASTERN AVE STE 301
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052
Practice Address - Country:US
Practice Address - Phone:702-852-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23231207RH0003X
NV7231207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ389751Medicaid
NV830004165OtherRAILROAD MEDICARE
AZ900001898OtherRAILROAD MEDICARE
NV002019528Medicaid
NV30021Medicare PIN
AZ389751Medicaid
F61061Medicare UPIN