MEDICARE: LISANDRA MARRERO MONTES MS SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	3059	PR

General Provider Information

NPI Number	:	1790144269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISANDRA MARRERO MONTES MS SLP

Provider Business Mailing Address
First Line	:	361 CALLE DEL PARQUE
Second Line	:	APT. 3F
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3703
Country	:	US
Telephone Number	:	787-629-7535
Fax Number	:

Provider Business Practice Location Address
First Line	:	361 CALLE DEL PARQUE
Second Line	:	APT. 3F
City	:	SAN JUAN
State	:	PR
Zip	:	00912-3703
Country	:	US
Telephone Number	:	787-629-7535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2016
Last Update Date	:	02/12/2016

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