Provider Demographics
NPI:1902457377
Name:MUNOH, SAMUEL TEZEH
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:TEZEH
Last Name:MUNOH
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 1:3801 KENILWORTH AVE APT 302E
Mailing Address - Street 2:
Mailing Address - City:BLADENSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20710-2131
Mailing Address - Country:US
Mailing Address - Phone:301-851-9239
Mailing Address - Fax:
Practice Address - Street 1:3801 KENILWORTH AVE APT 302E
Practice Address - Street 2:
Practice Address - City:BLADENSBURG
Practice Address - State:MD
Practice Address - Zip Code:20710-2131
Practice Address - Country:US
Practice Address - Phone:301-851-9239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA14667374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide