Provider Demographics
NPI:1184324329
Name:NAHIMANA, ALAIN PIERRE
Entity type:Individual
Prefix:
First Name:ALAIN
Middle Name:PIERRE
Last Name:NAHIMANA
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 1:11937 W MONTE VISTA RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-6453
Mailing Address - Country:US
Mailing Address - Phone:718-207-8511
Mailing Address - Fax:
Practice Address - Street 1:11937 W MONTE VISTA RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-6453
Practice Address - Country:US
Practice Address - Phone:718-207-8511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH8071251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health