Provider Demographics
NPI:1669162210
Name:BIZIMANA, PSCAL MUHITIRA
Entity type:Individual
Prefix:MR
First Name:PSCAL
Middle Name:MUHITIRA
Last Name:BIZIMANA
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 1:3824 26TH AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61265-4954
Mailing Address - Country:US
Mailing Address - Phone:309-206-8240
Mailing Address - Fax:
Practice Address - Street 1:3824 26TH AVE APT 3
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:IL
Practice Address - Zip Code:61265-4954
Practice Address - Country:US
Practice Address - Phone:309-206-8240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILB25567389001172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver