Provider Demographics
NPI:1326883661
Name:NDUWIMANA, RICHARD SERUTENGE
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:SERUTENGE
Last Name:NDUWIMANA
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 1:4500 STEINER RANCH BLVD APT 3508
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2360
Mailing Address - Country:US
Mailing Address - Phone:443-839-3691
Mailing Address - Fax:
Practice Address - Street 1:4500 STEINER RANCH BLVD APT 3508
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2360
Practice Address - Country:US
Practice Address - Phone:443-839-3691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency
No3104A0630XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Behavioral Disturbances