Healthcare Provider Details

I. General information

NPI: 1285421735
Provider Name (Legal Business Name): CERIA MOK YAM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2025
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 NW 87TH AVE STE 205
DORAL FL
33172-2656
US

IV. Provider business mailing address

3136 NW 99TH CT
DORAL FL
33172-1044
US

V. Phone/Fax

Practice location:
  • Phone: 786-714-8547
  • Fax:
Mailing address:
  • Phone: 786-714-8547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11038913
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: