Provider Demographics
NPI:1356319446
Name:LIRA, JOSE A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:A
Last Name:LIRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 KUHN DR.,
Mailing Address - Street 2:STE#200
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-3552
Mailing Address - Country:US
Mailing Address - Phone:619-482-7301
Mailing Address - Fax:619-482-7302
Practice Address - Street 1:841 KUHN DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3552
Practice Address - Country:US
Practice Address - Phone:619-482-7301
Practice Address - Fax:619-482-7302
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33913207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A339130Medicaid
CA00A339130Medicaid
CAWA33913CMedicare ID - Type Unspecified