Organization
DR. LISA LICEAGA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA LICEAGA DO (PHYSICIAN)
(949) 275-2718
Entity
Organization
Contact information
Practice address
831 S STATE ROAD 434, ALTAMONTE SPRINGS, FL 32714-3502
(407) 587-8600
Mailing address
12386 STATE ROAD 535 # 105, ORLANDO, FL 32836-6701
(407) 801-3295
(410) 907-7757
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
06/07/2023
Last updated
06/07/2023
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