Healthcare Provider Details

I. General information

NPI: 1083549984
Provider Name (Legal Business Name): LISANDRA DE LA CRUZ CURBELO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1462 CALLE PROF AUGUSTO RODRIGUEZ
SAN JUAN PR
00909-2199
US

IV. Provider business mailing address

4719 SW 144TH CT
MIAMI FL
33175-8904
US

V. Phone/Fax

Practice location:
  • Phone: 787-641-1616
  • Fax:
Mailing address:
  • Phone: 786-260-7328
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number17743-I
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: