Provider Demographics
NPI:1265054407
Name:MUNU, ISATU ALET
Entity type:Individual
Prefix:
First Name:ISATU
Middle Name:ALET
Last Name:MUNU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3003 SUMMER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-4896
Mailing Address - Country:US
Mailing Address - Phone:301-825-6599
Mailing Address - Fax:
Practice Address - Street 1:102 W EL DORADO BLVD # C1
Practice Address - Street 2:
Practice Address - City:FRIENDSWOOD
Practice Address - State:TX
Practice Address - Zip Code:77546-6516
Practice Address - Country:US
Practice Address - Phone:281-990-8448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-11
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD184141223P0700X
NJ22DI027935001223G0001X
TX393451223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX39345Medicaid
NJ22DI02793500Medicaid