| Lisette Portes Md Pa | |
|
9995 Sw 72nd St Ste 202 Miami FL 33173-4662 | |
| (305) 332-9821 | |
| (305) 356-4048 |
| Full Name | Lisette Portes Md Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 9995 Sw 72nd St Ste 202, Miami, Florida |
| Authorized Official Name and Position | Lisette Portes (MEDICAL DIRECTOR) |
| Authorized Official Contact | 3053329821 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lisette Portes Md Pa 3115 Sw 98th Ct Miami FL 33165-2954 Ph: (305) 332-9821 | Lisette Portes Md Pa 9995 Sw 72nd St Ste 202 Miami FL 33173-4662 Ph: (305) 332-9821 |
| NPI Number | 1720750631 |
|---|---|
| Provider Enumeration Date | 09/29/2021 |
| Last Update Date | 09/29/2021 |
| Medicare PECOS PAC ID | 2062810807 |
|---|---|
| Medicare Enrollment ID | O20211008002499 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720750631 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Lisette Portes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1508137670 PECOS PAC ID: 9931524972 Enrollment ID: I20200807000296 |
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