Healthcare Provider Details

I. General information

NPI: 1013519511
Provider Name (Legal Business Name): LISSETTE GARCIA VALDES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 S DIXIE HWY STE 405
BOCA RATON FL
33432-7454
US

IV. Provider business mailing address

5981 W 20TH LN
HIALEAH FL
33016-2665
US

V. Phone/Fax

Practice location:
  • Phone: 786-278-5903
  • Fax: 561-734-1460
Mailing address:
  • Phone: 305-297-2238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-142356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: