Healthcare Provider Details

I. General information

NPI: 1114889052
Provider Name (Legal Business Name): LISSANDRA TORRES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 NE MIAMI GARDENS DR STE 220F
NORTH MIAMI BEACH FL
33179-4720
US

IV. Provider business mailing address

16190 64TH PL N
LOXAHATCHEE FL
33470-5733
US

V. Phone/Fax

Practice location:
  • Phone: 786-523-3249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: