Provider Demographics
NPI:1326664160
Name:GONZALEZ VEITIA, LISLIE LISETE (MD)
Entity type:Individual
Prefix:
First Name:LISLIE
Middle Name:LISETE
Last Name:GONZALEZ VEITIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9980 CENTRAL PARK BLVD N STE 126
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1703
Mailing Address - Country:US
Mailing Address - Phone:561-369-7137
Mailing Address - Fax:561-405-6265
Practice Address - Street 1:9980 CENTRAL PARK BLVD N STE 126
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1703
Practice Address - Country:US
Practice Address - Phone:561-369-7137
Practice Address - Fax:561-405-6265
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FL162806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty