Healthcare Provider Details

I. General information

NPI: 1457294951
Provider Name (Legal Business Name): LISNEY PUPO MORA HHA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

425 E 32ND ST APT 20
HIALEAH FL
33013-3370
US

IV. Provider business mailing address

425 E 32ND ST APT 20
HIALEAH FL
33013-3370
US

V. Phone/Fax

Practice location:
  • Phone: 786-824-8028
  • Fax:
Mailing address:
  • Phone: 786-824-8028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: