Healthcare Provider Details

I. General information

NPI: 1457335234
Provider Name (Legal Business Name): JEMELLE JUNE MAYUGBA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9453 AEGEAN DR
BOCA RATON FL
33496-6684
US

IV. Provider business mailing address

2900 N MILITARY TRL SUITE 245
BOCA RATON FL
33431-6365
US

V. Phone/Fax

Practice location:
  • Phone: 561-951-3517
  • Fax: 561-208-1281
Mailing address:
  • Phone: 561-994-2007
  • Fax: 561-208-1281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberBM8431366
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME88349
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: