Provider Demographics
NPI:1124726013
Name:KUBWIMANA, CLAUDE
Entity type:Individual
Prefix:MR
First Name:CLAUDE
Middle Name:
Last Name:KUBWIMANA
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 1:4715 N BLACK CANYON HWY APT 2029
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-4078
Mailing Address - Country:US
Mailing Address - Phone:480-938-5370
Mailing Address - Fax:
Practice Address - Street 1:3420 E SHEA BLVD # 259
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3345
Practice Address - Country:US
Practice Address - Phone:602-860-2749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)