Provider Demographics
NPI:1477074094
Name:LIERAS, VINCENT (PA)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:LIERAS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30300 ANTELOPE RD APT 1826
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92584-9568
Mailing Address - Country:US
Mailing Address - Phone:619-203-4536
Mailing Address - Fax:
Practice Address - Street 1:31581 CANYON ESTATES DR
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92532-0424
Practice Address - Country:US
Practice Address - Phone:951-244-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA54581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine