Provider Demographics
NPI:1942264866
Name:LISBOA, SANDRA (MD)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:LISBOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CALLE PAISAJES
Mailing Address - Street 2:MIRADORES DE CAYEY
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-8600
Mailing Address - Country:US
Mailing Address - Phone:787-263-6178
Mailing Address - Fax:
Practice Address - Street 1:5 CALLE PAISAJES
Practice Address - Street 2:5 CALLE PAISAJES
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-8600
Practice Address - Country:US
Practice Address - Phone:787-263-6178
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7966208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
F99379Medicare UPIN
0029432Medicare PIN