Provider Demographics
NPI:1962121475
Name:RIQUENE, LISANDRA
Entity type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:RIQUENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8879 FONTAINEBLEAU BLVD
Mailing Address - Street 2:APTO 102B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172
Mailing Address - Country:US
Mailing Address - Phone:786-580-2426
Mailing Address - Fax:
Practice Address - Street 1:8879 FONTAINEBLEAU BVD
Practice Address - Street 2:APTO 102B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-3317
Practice Address - Country:US
Practice Address - Phone:786-580-2426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician