Provider Demographics
NPI:1437676657
Name:CARABAJO, LISSA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:LISSA
Middle Name:ALEXANDRA
Last Name:CARABAJO
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 1:102 W 183RD ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10453-1107
Mailing Address - Country:US
Mailing Address - Phone:917-574-1831
Mailing Address - Fax:
Practice Address - Street 1:102 W 183RD ST
Practice Address - Street 2:APT 1C
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:917-574-1831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program