Healthcare Provider Details

I. General information

NPI: 1891568739
Provider Name (Legal Business Name): LISBET ESPINOSA IZQUIERDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2023
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7955 NW 12TH ST STE 405
DORAL FL
33126-1823
US

IV. Provider business mailing address

7785 W 30TH CT APT 105
HIALEAH FL
33018-3858
US

V. Phone/Fax

Practice location:
  • Phone: 786-615-4409
  • Fax: 786-637-2974
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-301927
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: