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General NPI Number Information
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NPI Number | 1093910499
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Entity Type | Individual
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Provider Name | LISSETTE SELEM PHYSICIAN/MD
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 11/04/2020
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Provider Practice Location Address
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Address Line | 5803 NW 151 ST SUITE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2473
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Country | US
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Telephone | 305-696-8802
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Fax | 305-696-8156
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Provider Business Mailing Address
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Address Line | 5803 NW 151 ST SUITE 101
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City | MIAMI LAKES
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State | FL
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Zip | 33014-2473
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Country | US
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Telephone | 305-696-8802
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Fax | 305-696-8156
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 14764
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | ME128650
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License Number State | FL
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