Healthcare Provider Details

I. General information

NPI: 1902714793
Provider Name (Legal Business Name): LISSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 RANCHO BUENO DR
GEORGETOWN TX
78628-9523
US

IV. Provider business mailing address

116 RANCHO BUENO DR
GEORGETOWN TX
78628-9523
US

V. Phone/Fax

Practice location:
  • Phone: 512-843-1341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID ORSINI
Title or Position: DIRECTOR
Credential:
Phone: 330-541-6606