Individual
MR. KAYISABE ANDRE RUSAGARA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
155 S 300 W, SALT LAKE CITY, UT 84101-1217
(801) 467-6060
Mailing address
155 S 300 W, SALT LAKE CITY, UT 84101-1217
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/29/2021
Last updated
09/29/2021
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