MEDICARE: LISLIE LISETE GONZALEZ VEITIA MD

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	207Q00000X	Family Medicine Physician	162806	FL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1326664160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISLIE LISETE GONZALEZ VEITIA MD

Provider Business Mailing Address
First Line	:	9980 CENTRAL PARK BLVD N STE 126
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1703
Country	:	US
Telephone Number	:	561-369-7137
Fax Number	:	561-405-6265

Provider Business Practice Location Address
First Line	:	9980 CENTRAL PARK BLVD N STE 126
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-1703
Country	:	US
Telephone Number	:	561-369-7137
Fax Number	:	561-405-6265

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

Provider Enumeration Date	:	06/17/2020
Last Update Date	:	03/25/2026

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Directions to “ LISLIE LISETE GONZALEZ VEITIA MD” Practice Location

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