Provider Demographics
NPI:1053871202
Name:LABRADA LABRADA, LISBETH
Entity type:Individual
Prefix:
First Name:LISBETH
Middle Name:
Last Name:LABRADA LABRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5918 SW 133RD PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-5102
Mailing Address - Country:US
Mailing Address - Phone:305-984-3950
Mailing Address - Fax:
Practice Address - Street 1:601 E ROLLINS ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1248
Practice Address - Country:US
Practice Address - Phone:407-975-0412
Practice Address - Fax:407-975-0413
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC250310208000000X
FLME155674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics