Provider Demographics
NPI:1164395513
Name:GUEVARA PEREZ, LISANDRA (BS)
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:GUEVARA PEREZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 SW 267TH ST APT 304
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-8265
Mailing Address - Country:US
Mailing Address - Phone:786-806-0174
Mailing Address - Fax:
Practice Address - Street 1:14201 SW 267TH ST APT 304
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-8265
Practice Address - Country:US
Practice Address - Phone:786-806-0174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist