Individual
MS. LISSETTE M MEDINA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 662-8366
Mailing address
3100 SW 62ND AVE, MIAMI, FL 33155-3009
(305) 662-8366
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9105170
FL
Other
Enumeration date
03/12/2012
Last updated
03/12/2012
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