Provider Demographics
NPI:1831605658
Name:KARUGA, STEPHEN KABATHA (NP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:KABATHA
Last Name:KARUGA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4159 N RIO CANCION APT 46
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-7137
Mailing Address - Country:US
Mailing Address - Phone:978-828-7627
Mailing Address - Fax:800-423-6211
Practice Address - Street 1:6890 E SUNRISE DR STE 120-176
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85750
Practice Address - Country:US
Practice Address - Phone:978-828-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-15
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10690363LP0808X, 363LF0000X
MARN2257932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health