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General NPI Number Information
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NPI Number | 1457335234
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Entity Type | Individual
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Provider Name | JEMELLE JUNE MAYUGBA MD
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Gender | Female
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Dates
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Enumeration Date | 12/05/2005
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 9453 AEGEAN DR
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City | BOCA RATON
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State | FL
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Zip | 33496-6684
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Country | US
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Telephone | 561-951-3517
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Fax | 561-208-1281
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Provider Business Mailing Address
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Address Line | 2900 N MILITARY TRL SUITE 245
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City | BOCA RATON
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State | FL
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Zip | 33431-6365
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Country | US
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Telephone | 561-994-2007
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Fax | 561-208-1281
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number | BM8431366
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME88349
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License Number State | FL
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