Provider Demographics
NPI:1720962962
Name:MAVUNGO, ALEXANDRE BUIO
Entity type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:BUIO
Last Name:MAVUNGO
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 1:54 HILLCREST AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6821
Mailing Address - Country:US
Mailing Address - Phone:207-245-8881
Mailing Address - Fax:207-245-8881
Practice Address - Street 1:54 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6821
Practice Address - Country:US
Practice Address - Phone:207-245-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-01
Last Update Date:2025-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME8644349172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver