Provider Demographics
NPI:1073749057
Name:IGLESIAS, LYSETTE (MD)
Entity Type:Individual
Prefix:
First Name:LYSETTE
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8350 COMMERCE WAY APT 325
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1636
Mailing Address - Country:US
Mailing Address - Phone:786-502-7112
Mailing Address - Fax:
Practice Address - Street 1:7761 NW 146TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33016-1559
Practice Address - Country:US
Practice Address - Phone:305-381-5301
Practice Address - Fax:305-381-5541
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245766208000000X
FLME99374208000000X, 2080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics