Healthcare Provider Details

I. General information

NPI: 1710802392
Provider Name (Legal Business Name): LISANDRA GERENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DORADO DEL MAR JJ11
DORADO PR
00646
US

IV. Provider business mailing address

DORADO DEL MAR JJ11
DORADO PR
00646
US

V. Phone/Fax

Practice location:
  • Phone: 787-317-2966
  • Fax:
Mailing address:
  • Phone: 787-317-2966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number1487
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: