Provider Demographics
NPI:1689209116
Name:KAMAGAJU, ANGELIQUE MUKUNZI
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:MUKUNZI
Last Name:KAMAGAJU
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 1:7932 W HILTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-7418
Mailing Address - Country:US
Mailing Address - Phone:623-972-0191
Mailing Address - Fax:623-440-2427
Practice Address - Street 1:7932 W HILTON AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-7418
Practice Address - Country:US
Practice Address - Phone:623-972-0191
Practice Address - Fax:623-440-2427
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11290H253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care