Provider Demographics
NPI:1023752300
Name:MMUHONGELWA, RIZIKI
Entity type:Individual
Prefix:
First Name:RIZIKI
Middle Name:
Last Name:MMUHONGELWA
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 1:4612 N FESSENDEN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203-2088
Mailing Address - Country:US
Mailing Address - Phone:503-309-7913
Mailing Address - Fax:
Practice Address - Street 1:4612 N FESSENDEN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97203-2088
Practice Address - Country:US
Practice Address - Phone:503-309-7913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORE0700X0BMedicaid