Healthcare Provider Details

I. General information

NPI: 1528355278
Provider Name (Legal Business Name): LISSETTE SABOGAL R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3146
  • Fax: 305-575-3373
Mailing address:
  • Phone: 305-575-3146
  • Fax: 305-575-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH21736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: