Individual
FIDIA NIYONZIMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3249 TODD AVE, FORT WORTH, TX 76110-4534
(862) 888-7692
Mailing address
1325 DAJA LN APT 2402, GRAND PRAIRIE, TX 75050-7663
(862) 888-7692
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/26/2021
Last updated
09/07/2023
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