Basic Information
| Provider Information | |||||||||
| NPI: | 1235136854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NYAMUSWA | ||||||||
| FirstName: | GILBERT | ||||||||
| MiddleName: | MUDIWA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18000 STUDEBAKER RD STE 800 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627353226 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10001 S EASTERN AVE STE 301 | ||||||||
| Address2: | |||||||||
| City: | HENDERSON | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7028522017 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2005 | ||||||||
| LastUpdateDate: | 09/04/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 23231 | AZ | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 7231 | NV | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 389751 | 05 | AZ | MEDICAID | 830004165 | 01 | NV | RAILROAD MEDICARE | OTHER | 900001898 | 01 | AZ | RAILROAD MEDICARE | OTHER | 002019528 | 05 | NV | MEDICAID |