Provider Demographics
NPI:1063191781
Name:CUADRADO, LIZAIDA
Entity type:Individual
Prefix:
First Name:LIZAIDA
Middle Name:
Last Name:CUADRADO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIZAIDA
Other - Middle Name:
Other - Last Name:CUADRADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:RR 10 BOX 10170
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9510
Mailing Address - Country:US
Mailing Address - Phone:787-549-3516
Mailing Address - Fax:
Practice Address - Street 1:200 CALLE NORTE
Practice Address - Street 2:
Practice Address - City:DORADO
Practice Address - State:PR
Practice Address - Zip Code:00646-2714
Practice Address - Country:US
Practice Address - Phone:787-796-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-12
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7148103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool