Provider Demographics
NPI:1720845563
Name:NTIZIMIRA, BATACHOKA EVODE
Entity Type:Individual
Prefix:
First Name:BATACHOKA EVODE
Middle Name:
Last Name:NTIZIMIRA
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 1:1828 DARST AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45403-3106
Mailing Address - Country:US
Mailing Address - Phone:307-629-1722
Mailing Address - Fax:
Practice Address - Street 1:1828 DARST AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-3106
Practice Address - Country:US
Practice Address - Phone:307-629-1722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health