Healthcare Provider Details

I. General information

NPI: 1215745211
Provider Name (Legal Business Name): LISANDRA CABRERA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2024
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 CORAL WAY STE 2-19
MIAMI FL
33145-3438
US

IV. Provider business mailing address

305 FIFTH AVE
LEHIGH ACRES FL
33936-1427
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2837450
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: