Provider Demographics
NPI:1740722032
Name:PASCAL AMBROSE, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:PASCAL AMBROSE
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 1:7541 NW 16TH ST
Mailing Address - Street 2:UNIT 1411
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33313-5157
Mailing Address - Country:US
Mailing Address - Phone:786-277-1553
Mailing Address - Fax:
Practice Address - Street 1:7541 NW 16TH ST
Practice Address - Street 2:UNIT 1411
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33313-5157
Practice Address - Country:US
Practice Address - Phone:786-277-1553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist