Provider Demographics
NPI:1073229589
Name:MUNIZ, LISANDRA MUNIZ SR
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:MUNIZ
Last Name:MUNIZ
Suffix:SR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:919 NW 2ND AVE APT 512
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3936
Mailing Address - Country:US
Mailing Address - Phone:786-439-6581
Mailing Address - Fax:
Practice Address - Street 1:919 NW 2ND AVE APT 512
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-3936
Practice Address - Country:US
Practice Address - Phone:786-439-6581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-22-247611106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty