Healthcare Provider Details

I. General information

NPI: 1710318324
Provider Name (Legal Business Name): ALBERT MAYUNGBE SR. CPA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 12/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NW 183RD ST STE 402
MIAMI FL
33169-4540
US

IV. Provider business mailing address

111 NW 183RD ST STE 402
MIAMI FL
33169-4540
US

V. Phone/Fax

Practice location:
  • Phone: 305-342-1715
  • Fax: 305-651-4900
Mailing address:
  • Phone: 305-342-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number16855
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number299993690
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number299993690
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number299993690
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number299993690
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number299993690
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License Number299993690
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number299993690
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number299993690
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code225XE1200X
TaxonomyErgonomics Occupational Therapist
License Number299993690
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number299993690
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: