Healthcare Provider Details

I. General information

NPI: 1003764747
Provider Name (Legal Business Name): YAEMI MATIAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 55TH ST APT 108
NEW YORK NY
10022-4148
US

IV. Provider business mailing address

450 AUDUBON AVE
NEW YORK NY
10040-4546
US

V. Phone/Fax

Practice location:
  • Phone: 786-878-9169
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number007905
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: