Provider Demographics
NPI:1093019705
Name:LIRA, REBECCA (BA)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:LIRA
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 SAN GABRIEL PL
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2497
Mailing Address - Country:US
Mailing Address - Phone:562-222-1331
Mailing Address - Fax:562-222-1322
Practice Address - Street 1:5200 SAN GABRIEL PL
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2497
Practice Address - Country:US
Practice Address - Phone:562-222-1331
Practice Address - Fax:562-222-1322
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)