Provider Demographics
NPI:1801609185
Name:MUKABIRE, PETER
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:MUKABIRE
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 1:1040 S FOWLER LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95391-1409
Mailing Address - Country:US
Mailing Address - Phone:510-736-8524
Mailing Address - Fax:
Practice Address - Street 1:1040 S FOWLER LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95391-1409
Practice Address - Country:US
Practice Address - Phone:510-736-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-30
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2024088626363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health