Provider Demographics
NPI:1144202961
Name:LIRA, MARIA L (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:L
Last Name:LIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4833 SARATOGA BLVD
Mailing Address - Street 2:PMB 606
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-2213
Mailing Address - Country:US
Mailing Address - Phone:361-851-0000
Mailing Address - Fax:
Practice Address - Street 1:4613 S STAPLES ST STE C&D
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2605
Practice Address - Country:US
Practice Address - Phone:361-851-0000
Practice Address - Fax:361-653-2543
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXK0895208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8M1730OtherBCBS
TX030131902Medicaid
G697726Medicare UPIN