Provider Demographics
NPI:1336401652
Name:MUNONGO, FLORENCE BUMA (MED TECH)
Entity Type:Individual
Prefix:
First Name:FLORENCE
Middle Name:BUMA
Last Name:MUNONGO
Suffix:
Gender:F
Credentials:MED TECH
Other - Prefix:
Other - First Name:FLORENCE
Other - Middle Name:BUMA
Other - Last Name:MUNONGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3003 ROSALIND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6404
Mailing Address - Country:US
Mailing Address - Phone:301-291-1862
Mailing Address - Fax:
Practice Address - Street 1:3003 ROSALIND AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6404
Practice Address - Country:US
Practice Address - Phone:301-291-1862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-12
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMT0130346251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health