Healthcare Provider Details

I. General information

NPI: 1134485915
Provider Name (Legal Business Name): LISSETTE MIZRAHI CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 03/06/2020
Certification Date: 03/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 UNIVERSITY DR
CORAL GABLES FL
33146-2008
US

IV. Provider business mailing address

7600 S RED RD STE 229
SOUTH MIAMI FL
33143-5408
US

V. Phone/Fax

Practice location:
  • Phone: 786-308-3000
  • Fax:
Mailing address:
  • Phone: 305-448-9018
  • Fax: 305-448-1895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9266548
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN9266548
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: