MEDICARE: ALBERT MAYUNGBE SR. CPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	299993690	FL
2	164W00000X	Licensed Practical Nurse	299993690	FL
3	224Z00000X	Occupational Therapy Assistant	299993690	FL
4	225100000X	Physical Therapist	299993690	FL
5	2251E1200X	Ergonomics Physical Therapist	299993690	FL
6	225200000X	Physical Therapy Assistant	299993690	FL
7	225X00000X	Occupational Therapist	299993690	FL
8	225XE1200X	Ergonomics Occupational Therapist	299993690	FL
9	235Z00000X	Speech-Language Pathologist	299993690	FL
10	376J00000X	Homemaker	16855	FL
11	376K00000X	Nurse's Aide	299993690	FL

General Provider Information

NPI Number	:	1710318324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALBERT MAYUNGBE SR. CPA

Provider Business Mailing Address
First Line	:	111 NW 183RD ST STE 402
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-4540
Country	:	US
Telephone Number	:	305-342-1715
Fax Number	:

Provider Business Practice Location Address
First Line	:	111 NW 183RD ST STE 402
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33169-4540
Country	:	US
Telephone Number	:	305-342-1715
Fax Number	:	305-651-4900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/06/2013

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