Healthcare Provider Details

I. General information

NPI: 1790461135
Provider Name (Legal Business Name): CHRISTIAN EDGARDO YAMBO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 03/27/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SW 40TH ST, MIAMI, FL 33175
MIAMI FL
33175
US

IV. Provider business mailing address

11750 SW 40TH ST, MIAMI, FL 33175
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 954-829-0639
  • Fax:
Mailing address:
  • Phone: 954-829-0639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: