Provider Demographics
NPI:1699461772
Name:LUBWAMA, PROSCOVIA BARBARA (PMHNP)
Entity type:Individual
Prefix:
First Name:PROSCOVIA
Middle Name:BARBARA
Last Name:LUBWAMA
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:PROSCOVIA
Other - Middle Name:BARBARA
Other - Last Name:NAMBATYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14338 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-1944
Mailing Address - Country:US
Mailing Address - Phone:818-401-3293
Mailing Address - Fax:
Practice Address - Street 1:14338 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-1944
Practice Address - Country:US
Practice Address - Phone:818-401-3293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-12
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95024849363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health