Provider Demographics
NPI:1245608165
Name:LIRA, NORMA ANGELICA (RDA)
Entity Type:Individual
Prefix:MRS
First Name:NORMA
Middle Name:ANGELICA
Last Name:LIRA
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:ANGELICA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDA
Mailing Address - Street 1:720 MESA CT
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4021
Mailing Address - Country:US
Mailing Address - Phone:909-367-0345
Mailing Address - Fax:
Practice Address - Street 1:720 MESA CT
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4021
Practice Address - Country:US
Practice Address - Phone:909-367-0345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-09
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50688126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant