Healthcare Provider Details

I. General information

NPI: 1750064028
Provider Name (Legal Business Name): LISLEY LOPEZ GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2023
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1535 MEDFORD PL
LEHIGH ACRES FL
33936-5945
US

IV. Provider business mailing address

1535 MEDFORD PL
LEHIGH ACRES FL
33936-5945
US

V. Phone/Fax

Practice location:
  • Phone: 239-244-6299
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: