Healthcare Provider Details

I. General information

NPI: 1497492557
Provider Name (Legal Business Name): LISBET FERNANDEZ MONTERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 NW 7TH ST APT 201
MIAMI FL
33126-2266
US

IV. Provider business mailing address

4705 NW 7TH ST APT 201
MIAMI FL
33126-2266
US

V. Phone/Fax

Practice location:
  • Phone: 786-241-3527
  • Fax:
Mailing address:
  • Phone: 786-241-3527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-63729
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-206355
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: