Healthcare Provider Details

I. General information

NPI: 1902721707
Provider Name (Legal Business Name): LISANDRA SANTIAGO M.S., SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 DE INFANTERIA ESQUINA VICTORIA
LAJAS PR
00667
US

IV. Provider business mailing address

199 CALLE CANARIO
CABO ROJO PR
00623-4230
US

V. Phone/Fax

Practice location:
  • Phone: 787-899-8006
  • Fax:
Mailing address:
  • Phone: 787-974-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number4777
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: