Provider Demographics
NPI:1326658303
Name:HIYARI, MANIRAKIZA (NEMT)
Entity Type:Individual
Prefix:
First Name:MANIRAKIZA
Middle Name:
Last Name:HIYARI
Suffix:
Gender:M
Credentials:NEMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 BRIGHT LOTUS LANE
Mailing Address - Street 2:
Mailing Address - City:ROSHARON
Mailing Address - State:TX
Mailing Address - Zip Code:77583
Mailing Address - Country:US
Mailing Address - Phone:281-546-6799
Mailing Address - Fax:
Practice Address - Street 1:926 BRIGHT LOTUS LANE
Practice Address - Street 2:
Practice Address - City:ROSHARON
Practice Address - State:TX
Practice Address - Zip Code:77583
Practice Address - Country:US
Practice Address - Phone:281-546-6799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12231351Medicaid