Provider Demographics
NPI:1720750631
Name:LISETTE PORTES MD PA
Entity Type:Organization
Organization Name:LISETTE PORTES MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LISETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PORTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-332-9821
Mailing Address - Street 1:3115 SW 98TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2954
Mailing Address - Country:US
Mailing Address - Phone:305-332-9821
Mailing Address - Fax:305-356-4048
Practice Address - Street 1:9995 SW 72ND ST STE 202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4662
Practice Address - Country:US
Practice Address - Phone:305-332-9821
Practice Address - Fax:305-356-4048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care