NPIMap

Organization Active NPI

Lissette D Cortazar Mdpa

  • Psychiatry Physician
  • Miami, FL
National Provider Identifier
1497223341
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
LISSETTE D CORTAZAR MDPA
Practice address
3661 S Miami Ave Ste 402
Miami, FL 33133-4230
Phone
(305) 815-0055
Fax
(347) 493-3512
NPI assigned
Nov 8, 2018
Last updated
Jun 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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

Authorized official

Name
Dr. Lissette D Cortazar, MDNPI 1477850410
Title
President
Phone
(786) 205-4066

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X Primary

Addresses

Primary practice location

3661 S Miami Ave Ste 402
Miami, FL 33133-4230

Mailing address

3661 S Miami
Suite 402
Miami, FL 33133-4330
Phone (305) 815-0055

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190610002509 FL Part B Supplier - Clinic/Group Practice 7012240880 Receives reassigned benefits from 3 practitioners
Practice locations: Miami, FL

National Provider Directory

National Provider Directory

Locations

3850 SW 87th Ave
Ste 202
Miami, FL 33165
Phone (786) 536-7891

Networks

  • HealthSun Health Plans Network

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1591747200000",
    "number": "1497223341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3661 S MIAMI",
            "address_2": "SUITE 402",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331334330",
            "telephone_number": "305-815-0055",
            "fax_number": "347-493-3512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3661 S MIAMI AVE STE 402",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331334230",
            "telephone_number": "305-815-0055",
            "fax_number": "347-493-3512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LISSETTE D CORTAZAR MDPA",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-11-08",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A",
        "authorized_official_last_name": "CORTAZAR",
        "authorized_official_first_name": "LISSETTE",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-205-4066",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.