Healthcare Provider Details

I. General information

NPI: 1487259859
Provider Name (Legal Business Name): LISSETT DE LA CRUZ CAGIGAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 09/29/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15412 SW 177TH TER
MIAMI FL
33187-6798
US

IV. Provider business mailing address

15412 SW 177TH TER
MIAMI FL
33187-6798
US

V. Phone/Fax

Practice location:
  • Phone: 786-870-2236
  • Fax:
Mailing address:
  • Phone: 786-870-2236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: