Provider Demographics
NPI:1134099542
Name:MAGUWUDZE, CHIONISO
Entity type:Individual
Prefix:
First Name:CHIONISO
Middle Name:
Last Name:MAGUWUDZE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 W SAHARA AVE APT 1147
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-5908
Mailing Address - Country:US
Mailing Address - Phone:661-416-5351
Mailing Address - Fax:
Practice Address - Street 1:9901 W SAHARA AVE APT 1147
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-5908
Practice Address - Country:US
Practice Address - Phone:661-416-5351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-10
Last Update Date:2025-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVBACB1368272106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician