Provider Demographics
NPI:1215214796
Name:TIRA, DIANA G (RDHAP)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:G
Last Name:TIRA
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4467 AVENIDA DE LAS FLORES
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2952
Mailing Address - Country:US
Mailing Address - Phone:714-779-9171
Mailing Address - Fax:
Practice Address - Street 1:4467 AVENIDA DE LAS FLORES
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2952
Practice Address - Country:US
Practice Address - Phone:714-779-9171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA352124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist