Provider Demographics
NPI:1497493522
Name:GOMEZ SANCHEZ, LISANDRA DE LA C
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:DE LA C
Last Name:GOMEZ SANCHEZ
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 1:3127 NW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-6327
Mailing Address - Country:US
Mailing Address - Phone:786-382-3772
Mailing Address - Fax:
Practice Address - Street 1:3127 NW 28TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-6327
Practice Address - Country:US
Practice Address - Phone:786-382-3772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty