Individual
LISA LICEAGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
11100 EUCLID AVE, CLEVELAND, OH 44106-1716
(216) 844-8447
Mailing address
PO BOX 947407, ATLANTA, GA 30394-7407
(941) 917-2600
(941) 917-7884
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
34.015963
OH
208100000X
Physical Medicine & Rehabilitation Physician
Primary
OS19884
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
118993200
—
FL
Enumeration date
06/17/2018
Last updated
09/04/2025
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