Provider Demographics
NPI:1851387161
Name:NIRENBERG, LISSA H (AP, DOM)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:H
Last Name:NIRENBERG
Suffix:
Gender:F
Credentials:AP, DOM
Other - Prefix:
Other - First Name:LISSA
Other - Middle Name:
Other - Last Name:NIRENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AP, DOM
Mailing Address - Street 1:15540 PALMETTO LAKE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33157-1752
Mailing Address - Country:US
Mailing Address - Phone:305-323-3123
Mailing Address - Fax:877-809-2795
Practice Address - Street 1:195 GIRALDA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5208
Practice Address - Country:US
Practice Address - Phone:305-567-1973
Practice Address - Fax:305-567-1974
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 1850171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0904OtherBCBS PROVIDER #