Provider Demographics
NPI:1396457149
Name:MULUMBA, ISABELLE BUJIBUNGI
Entity type:Individual
Prefix:
First Name:ISABELLE
Middle Name:BUJIBUNGI
Last Name:MULUMBA
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 1:1411 N BECKLEY AVE STE 366
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75203-1592
Mailing Address - Country:US
Mailing Address - Phone:214-941-2777
Mailing Address - Fax:214-941-2929
Practice Address - Street 1:1411 N BECKLEY AVE STE 366
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75203-1592
Practice Address - Country:US
Practice Address - Phone:214-941-2777
Practice Address - Fax:214-941-2929
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-22
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1099954363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner