Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 299993690 | FL |
N | 225100000X | Physical Therapist | 299993690 | FL |
N | 2251E1200X | Ergonomics | 299993690 | FL |
N | 225XE1200X | Ergonomics | 299993690 | FL |
N | 225200000X | Physical Therapy Assistant | 299993690 | FL |
N | 225X00000X | Occupational Therapist | 299993690 | FL |
N | 2251E1200X | Ergonomics | 299993690 | FL |
N | 225XE1200X | Ergonomics | 299993690 | FL |
NPI | 1710318324 |
---|---|
Provider Name | Albert Mayungbe SR. |
First Address | Miami, FL 33169-4540 |
Second Address | Miami, FL 33169-4540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2013 |
Last Update Date | 06/12/2013 |