| Lissette D Cortazar Mdpa | |
|
3661 S Miami Ave Ste 402 Miami FL 33133-4230 | |
| (305) 815-0055 | |
| (347) 493-3512 |
| Full Name | Lissette D Cortazar Mdpa |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 3661 S Miami Ave Ste 402, Miami, Florida |
| Authorized Official Name and Position | Lissette D Cortazar (PRESIDENT) |
| Authorized Official Contact | 7862054066 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lissette D Cortazar Mdpa 3661 S Miami Suite 402 Miami FL 33133-4330 Ph: (305) 815-0055 | Lissette D Cortazar Mdpa 3661 S Miami Ave Ste 402 Miami FL 33133-4230 Ph: (305) 815-0055 |
| NPI Number | 1497223341 |
|---|---|
| Provider Enumeration Date | 11/08/2018 |
| Last Update Date | 06/10/2020 |
| Certification Date | 06/10/2020 |
| Medicare PECOS PAC ID | 7012240880 |
|---|---|
| Medicare Enrollment ID | O20190610002509 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497223341 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Lissette Cortazar |
|---|---|
| Provider Type | Practitioner - Neuropsychiatry |
| Provider Identifiers | NPI Number: 1477850410 PECOS PAC ID: 5092092874 Enrollment ID: I20170503002470 |
| Provider Name | Alberto Rojas |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1104357839 PECOS PAC ID: 4385916980 Enrollment ID: I20200625001801 |
| Provider Name | Antonio Manuel Martinez Garcia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336635838 PECOS PAC ID: 4082021290 Enrollment ID: I20210405001364 |
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