Provider Demographics
NPI:1780482091
Name:FUKUOKA HAKOZAKI, THAISA YUMI
Entity type:Individual
Prefix:MRS
First Name:THAISA
Middle Name:YUMI
Last Name:FUKUOKA HAKOZAKI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17773 SW 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-3924
Mailing Address - Country:US
Mailing Address - Phone:954-589-2347
Mailing Address - Fax:954-301-2246
Practice Address - Street 1:719 NE 83RD TER APT 210
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-3853
Practice Address - Country:US
Practice Address - Phone:786-508-6755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician