Provider Demographics
NPI:1710577887
Name:CHIG FERNANDEZ, LISET
Entity Type:Individual
Prefix:
First Name:LISET
Middle Name:
Last Name:CHIG FERNANDEZ
Suffix:
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 1:830 SE 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5502
Mailing Address - Country:US
Mailing Address - Phone:786-346-8708
Mailing Address - Fax:
Practice Address - Street 1:830 SE 1ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-5502
Practice Address - Country:US
Practice Address - Phone:786-346-8708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician