Provider Demographics
NPI:1437125036
Name:LOPEZ-LIRA, THELMA (MD)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:
Last Name:LOPEZ-LIRA
Suffix:
Gender:F
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:PO BOX 271402
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78427
Mailing Address - Country:US
Mailing Address - Phone:361-980-1201
Mailing Address - Fax:361-980-1401
Practice Address - Street 1:4525 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2603
Practice Address - Country:US
Practice Address - Phone:361-980-1201
Practice Address - Fax:361-980-1401
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-24
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK01152084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096778802Medicaid
TX0061BKOtherBCBS OF TX
0061BKMedicare ID - Type Unspecified
TX096778802Medicaid