Provider Demographics
NPI:1578210738
Name:OJEDA URGELLES, LISSET (BACB)
Entity Type:Individual
Prefix:MRS
First Name:LISSET
Middle Name:
Last Name:OJEDA URGELLES
Suffix:
Gender:F
Credentials:BACB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24931 SW 120TH PL
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5980
Mailing Address - Country:US
Mailing Address - Phone:305-799-8724
Mailing Address - Fax:
Practice Address - Street 1:24931 SW 120TH PL
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5980
Practice Address - Country:US
Practice Address - Phone:305-799-8724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLI-21-50487103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023247000Medicaid