Healthcare Provider Details

I. General information

NPI: 1851387161
Provider Name (Legal Business Name): LISSA H. NIRENBERG AP, DOM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISSA NIRENBERG AP, DOM

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 GIRALDA AVE
CORAL GABLES FL
33134-5208
US

IV. Provider business mailing address

15540 PALMETTO LAKE DR
MIAMI FL
33157-1752
US

V. Phone/Fax

Practice location:
  • Phone: 305-567-1973
  • Fax: 305-567-1974
Mailing address:
  • Phone: 305-323-3123
  • Fax: 877-809-2795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP 1850
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: