Provider Demographics
NPI:1174856934
Name:KANDRA, LISA VERONICA (ATR)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:VERONICA
Last Name:KANDRA
Suffix:
Gender:F
Credentials:ATR
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:KANDRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATR
Mailing Address - Street 1:PO BOX 5232
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90409-5232
Mailing Address - Country:US
Mailing Address - Phone:310-424-0656
Mailing Address - Fax:
Practice Address - Street 1:3200 MOTOR AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-3710
Practice Address - Country:US
Practice Address - Phone:310-424-0656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program