Provider Demographics
NPI:1598071508
Name:SUAREZ, LISANDRA (MT)
Entity Type:Individual
Prefix:MRS
First Name:LISANDRA
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:UTUADO
Mailing Address - State:PR
Mailing Address - Zip Code:00641-2194
Mailing Address - Country:US
Mailing Address - Phone:787-316-2879
Mailing Address - Fax:
Practice Address - Street 1:CARR.10 KM. 75.6 BO. HATO VIEJO
Practice Address - Street 2:SOLAR # 1
Practice Address - City:ARECIBO
Practice Address - State:PR
Practice Address - Zip Code:00612
Practice Address - Country:US
Practice Address - Phone:787-816-2600
Practice Address - Fax:787-816-2600
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1274291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory