Provider Demographics
NPI:1154037513
Name:MBUVA, FESTUS KASYOKA
Entity type:Individual
Prefix:
First Name:FESTUS
Middle Name:KASYOKA
Last Name:MBUVA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-3212
Mailing Address - Country:US
Mailing Address - Phone:197-865-4153
Mailing Address - Fax:
Practice Address - Street 1:167 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3212
Practice Address - Country:US
Practice Address - Phone:197-865-4153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health