Organization
LISSA COMPANY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA MIRAMBEAU-BROUSSARD ADMINISTRATOR (CEO)
(845) 405-9970
Entity
Organization
Contact information
Practice address
7593 HAMPTON BLVD, NORTH LAUDERDALE, FL 33068-5586
(845) 405-9970
(800) 577-6271
Mailing address
2630 W BROWARD BLVD STE 203, FORT LAUDERDALE, FL 33312-1315
(800) 577-6271
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
05/27/2022
Last updated
05/27/2022
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