Healthcare Provider Details

I. General information

NPI: 1265633846
Provider Name (Legal Business Name): YANURYS TAIT LMT RCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 CORAL WAY STE 417
MIAMI FL
33155-1693
US

IV. Provider business mailing address

7171 CORAL WAY STE 417
MIAMI FL
33155-1693
US

V. Phone/Fax

Practice location:
  • Phone: 305-266-7122
  • Fax: 305-266-7141
Mailing address:
  • Phone: 305-266-7122
  • Fax: 305-266-7141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCH 8380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: