Provider Demographics
NPI:1457042913
Name:HABIYAREMYE, PASCAL THURAM
Entity type:Individual
Prefix:
First Name:PASCAL
Middle Name:THURAM
Last Name:HABIYAREMYE
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 1:4105 W SAINT CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-4980
Mailing Address - Country:US
Mailing Address - Phone:602-410-0159
Mailing Address - Fax:
Practice Address - Street 1:2828 N CENTRAL AVE # 1100C
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1021
Practice Address - Country:US
Practice Address - Phone:480-228-1228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-16
Last Update Date:2025-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ223694163WA0400X
AZRNP223694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)