Healthcare Provider Details

I. General information

NPI: 1073478962
Provider Name (Legal Business Name): FLAVIO YOSHIAKI MAYUMI LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 N BAYSHORE DR APT 2812
MIAMI FL
33132-3211
US

IV. Provider business mailing address

1750 N BAYSHORE DR APT 2812
MIAMI FL
33132-3211
US

V. Phone/Fax

Practice location:
  • Phone: 305-793-7801
  • Fax:
Mailing address:
  • Phone: 305-793-7801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03227
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: