Provider Demographics
NPI:1679788483
Name:RUBIO-FERNANDEZ, LISANDRA (BA)
Entity Type:Individual
Prefix:MS
First Name:LISANDRA
Middle Name:
Last Name:RUBIO-FERNANDEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:L5 CALLE JESUS T PINERO
Mailing Address - Street 2:URB. CAROLINA ALTA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7144
Mailing Address - Country:US
Mailing Address - Phone:787-257-8527
Mailing Address - Fax:
Practice Address - Street 1:L5 CALLE JESUS T PINERO
Practice Address - Street 2:URB. CAROLINA ALTA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-7144
Practice Address - Country:US
Practice Address - Phone:787-257-8527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker