Provider Demographics
NPI:1346694965
Name:VAZQUEZ LOPEZ, LISANDRIE MARIE
Entity Type:Individual
Prefix:
First Name:LISANDRIE
Middle Name:MARIE
Last Name:VAZQUEZ LOPEZ
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:RESIDENCIAL VISTA HERMOSA
Mailing Address - Street 2:SAN JUAN
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921
Mailing Address - Country:US
Mailing Address - Phone:787-781-7465
Mailing Address - Fax:
Practice Address - Street 1:RESIDENCIAL VISTA HERMOSA
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-0092
Practice Address - Country:US
Practice Address - Phone:787-299-5036
Practice Address - Fax:787-299-5036
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22928104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker