Healthcare Provider Details

I. General information

NPI: 1699024265
Provider Name (Legal Business Name): LISETT MUCI B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISETT ALVAREZ B.A

II. Dates (important events)

Enumeration Date: 08/29/2012
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 S MIAMI AVE STE 700
MIAMI FL
33130-1628
US

IV. Provider business mailing address

1120 NW 14 STREET #1210
MIAMI FL
33136-1628
US

V. Phone/Fax

Practice location:
  • Phone: 786-218-4329
  • Fax: 305-779-9601
Mailing address:
  • Phone: 786-303-2924
  • Fax: 305-243-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: