Individual
LISSELOT VICIOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
104 DOUGLAS ST, HARTFORD, CT 06114-2421
(860) 890-3032
Mailing address
101 SOUTH ST FL 2, HARTFORD, CT 06110-1967
(860) 890-3032
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/27/2018
Last updated
07/27/2018
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