Provider Demographics
NPI:1942206115
Name:PEREZ-COLON, LISANDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:LISANDRA
Middle Name:
Last Name:PEREZ-COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB BOSQUE SENORIAL
Mailing Address - Street 2:2607 CALLE PALMA SIERRA
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728
Mailing Address - Country:US
Mailing Address - Phone:939-992-9068
Mailing Address - Fax:787-812-2948
Practice Address - Street 1:EDIF CENTRO CARIBE SUITE 101-C
Practice Address - Street 2:2053 PONCE BY PASS
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-1379
Practice Address - Country:US
Practice Address - Phone:939-992-9068
Practice Address - Fax:787-812-2948
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-22
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR13182207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-11252Medicare UPIN
PR002-2397Medicare ID - Type UnspecifiedM.D.