Basic Information
| Provider Information | |||||||||
| NPI: | 1750347928 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FIGUEROA | ||||||||
| FirstName: | LISSAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 405 AVE ESMERALDA | ||||||||
| Address2: | PMB376 | ||||||||
| City: | GUAYNABO | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009694466 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | BARRIO MONACILLOS, CARRETERA 22 | ||||||||
| Address2: | PASEO DR. JOSE CELSO BARBOSA | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009350001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7877773535 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 03/20/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | 2540034 | PR | Y | Emergency Medical Service Providers | Personal Emergency Response Attendant |
ID Information
| ID | Type | State | Issuer | Description | 22988 | 01 | PR | TRIPLE -S, INC | OTHER |