Provider Demographics
NPI:1609923440
Name:GUAJARDO, LISA FRANCES (LM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:FRANCES
Last Name:GUAJARDO
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 E CYPRESS LN APT 206
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-4150
Mailing Address - Country:US
Mailing Address - Phone:954-548-8092
Mailing Address - Fax:954-636-8226
Practice Address - Street 1:800 E CYPRESS LN APT 206
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4150
Practice Address - Country:US
Practice Address - Phone:954-548-8092
Practice Address - Fax:954-636-8226
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000188175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay