Provider Demographics
NPI:1508915984
Name:ALFONSO, LISANDRA
Entity Type:Individual
Prefix:MRS
First Name:LISANDRA
Middle Name:
Last Name:ALFONSO
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:HC 1 BOX 4439
Mailing Address - Street 2:
Mailing Address - City:BAJADERO
Mailing Address - State:PR
Mailing Address - Zip Code:00616-9708
Mailing Address - Country:US
Mailing Address - Phone:787-898-5730
Mailing Address - Fax:787-820-5656
Practice Address - Street 1:HC 1 BOX 4439
Practice Address - Street 2:
Practice Address - City:BAJADERO
Practice Address - State:PR
Practice Address - Zip Code:00616-9708
Practice Address - Country:US
Practice Address - Phone:787-898-5730
Practice Address - Fax:787-820-5656
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5748183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician