Provider Demographics
NPI:1669912648
Name:VINARDELL, LISANDRA (PA-C)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:VINARDELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LISANDRA
Other - Middle Name:
Other - Last Name:TORRES OCHOA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100905
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1693
Mailing Address - Country:US
Mailing Address - Phone:786-594-6880
Mailing Address - Fax:
Practice Address - Street 1:1150 CAMPO SANO AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33146-1174
Practice Address - Country:US
Practice Address - Phone:786-268-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 9110114363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant