Provider Demographics
NPI:1316588494
Name:HIRE, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HIRE
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 1:423A W RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94801-3864
Mailing Address - Country:US
Mailing Address - Phone:510-872-9584
Mailing Address - Fax:
Practice Address - Street 1:4049 CANON AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2225
Practice Address - Country:US
Practice Address - Phone:510-872-9584
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider