Provider Demographics
NPI:1518397488
Name:LIRA, JESUS ENRIQUE JR (RD)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ENRIQUE
Last Name:LIRA
Suffix:JR
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5711 SPRINGFIELD AVE
Mailing Address - Street 2:STE. B
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-3282
Mailing Address - Country:US
Mailing Address - Phone:956-712-9988
Mailing Address - Fax:956-791-4888
Practice Address - Street 1:5711 SPRINGFIELD AVE
Practice Address - Street 2:STE. B
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3282
Practice Address - Country:US
Practice Address - Phone:956-712-9988
Practice Address - Fax:956-791-4888
Is Sole Proprietor?:No
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT82292133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered