Dr. Lisa Liceaga, LLC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

Legal business name

DR. LISA LICEAGA, LLC

Practice address

831 S State Road 434
Altamonte Springs, FL 32714-3502

Phone

(407) 587-8600

NPI assigned

Jun 7, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lisa Liceaga, DONPI 1215421979

Title

Physician

Phone

(949) 275-2718

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lisa Liceaga, DO

  • Physical Medicine & Rehabilitation Physician
  • Cleveland, OH
  • NPI 1215421979

  FL

  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686096000000",
    "number": "1447944830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12386 STATE ROAD 535 # 105",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328366701",
            "telephone_number": "407-801-3295",
            "fax_number": "410-907-7757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "831 S STATE ROAD 434",
            "city": "ALTAMONTE SPRINGS",
            "state": "FL",
            "postal_code": "327143502",
            "telephone_number": "407-587-8600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. LISA LICEAGA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-07",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A",
        "authorized_official_last_name": "LICEAGA",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "949-275-2718",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Medical Specialty Clinic/Center in Altamonte Springs, FL
• Providers in Altamonte Springs, FL by specialty
• Medical Specialty Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.