Healthcare Provider Details

I. General information

NPI: 1548182629
Provider Name (Legal Business Name): LISETTE MARGARITA CALDERON BACH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9630 NW 2ND ST APT 208
PEMBROKE PINES FL
33024-6287
US

IV. Provider business mailing address

9630 NW 2ND ST APT 208
PEMBROKE PINES FL
33024-6287
US

V. Phone/Fax

Practice location:
  • Phone: 754-277-8442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA-1-26-2828461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: