Healthcare Provider Details

I. General information

NPI: 1073749057
Provider Name (Legal Business Name): LYSETTE IGLESIAS M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 02/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7761 NW 146TH ST
MIAMI LAKES FL
33016-1559
US

IV. Provider business mailing address

8350 COMMERCE WAY APT 325
MIAMI LAKES FL
33016-1636
US

V. Phone/Fax

Practice location:
  • Phone: 305-381-5301
  • Fax: 305-381-5541
Mailing address:
  • Phone: 786-502-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number245766
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME99374
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberME99374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: