Healthcare Provider Details

I. General information

NPI: 1457002941
Provider Name (Legal Business Name): YAZMIN VALDES DAOM, LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2022
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

IV. Provider business mailing address

1475 NW 12TH AVE
MIAMI FL
33136-1002
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-5302
  • Fax: 305-243-5274
Mailing address:
  • Phone: 305-243-5302
  • Fax: 305-243-5274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number500
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberTPAP8
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: