Healthcare Provider Details

I. General information

NPI: 1326664160
Provider Name (Legal Business Name): LISLIE LISETE GONZALEZ VEITIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD STE D730
BOYNTON BEACH FL
33437-3725
US

IV. Provider business mailing address

10301 HAGEN RANCH RD STE D730
BOYNTON BEACH FL
33437-3725
US

V. Phone/Fax

Practice location:
  • Phone: 561-423-1325
  • Fax: 561-760-4418
Mailing address:
  • Phone: 561-423-1325
  • Fax: 561-760-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number162806
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number162806
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: