Healthcare Provider Details

I. General information

NPI: 1497063242
Provider Name (Legal Business Name): LISA MARIE DORTO FREEMAN CAA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA M. DORTO CAA

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 172ND AVE
MIRAMAR FL
33029
US

IV. Provider business mailing address

7700 W SUNRISE BLVD
PLANTATION FL
33322-4113
US

V. Phone/Fax

Practice location:
  • Phone: 954-538-4600
  • Fax: 954-538-4615
Mailing address:
  • Phone: 720-462-5373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA63
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: