Healthcare Provider Details

I. General information

NPI: 1609462761
Provider Name (Legal Business Name): LUBISLEY LA TORRE HERNANDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711B SEAGIRT AVE
FAR ROCKAWAY NY
11691-5730
US

IV. Provider business mailing address

340 NW 132ND CT
MIAMI FL
33182-1657
US

V. Phone/Fax

Practice location:
  • Phone: 718-831-2755
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF354845-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: