MEDICARE: LISBET IGLESIAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	RBT-21-183916	FL
2	103K00000X	Behavior Analyst	BCBA1-24-72991	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053061879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISBET IGLESIAS

Provider Business Mailing Address
First Line	:	10176 CEDAR DUNE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33624-5044
Country	:	US
Telephone Number	:	813-504-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	7109 N ARMENIA AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5262
Country	:	US
Telephone Number	:	813-331-0809
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	05/27/2024

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Directions to “ LISBET IGLESIAS ” Practice Location

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