Healthcare Provider Details

I. General information

NPI: 1447454566
Provider Name (Legal Business Name): LISANDRA MARIANE MARQUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 11/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SAN JUAN CITY HOSPITAL PEDIATRICS DEPARTMENT CENTRO MEDICO
SAN JUAN PR
00936
US

IV. Provider business mailing address

LOS PICACHOS CC17 MANSIONES DE CAROLINA
CAROLINA PR
00987
US

V. Phone/Fax

Practice location:
  • Phone: 787-766-2222
  • Fax:
Mailing address:
  • Phone: 787-354-3996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17046
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: