Healthcare Provider Details

I. General information

NPI: 1699639336
Provider Name (Legal Business Name): YAIMI CARBONELL PEREZ MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12130 SAINT ANDREWS PL APT 104
MIRAMAR FL
33025-0702
US

IV. Provider business mailing address

12130 SAINT ANDREWS PL APT 104
MIRAMAR FL
33025-0702
US

V. Phone/Fax

Practice location:
  • Phone: 305-984-9642
  • Fax:
Mailing address:
  • Phone: 305-984-9642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number106893
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: