Provider Demographics
NPI:1669540217
Name:MARIA LUISA LIRA MD PA
Entity type:Organization
Organization Name:MARIA LUISA LIRA MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNESTO
Authorized Official - Middle Name:
Authorized Official - Last Name:LIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-851-0000
Mailing Address - Street 1:4621 S STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-2605
Mailing Address - Country:US
Mailing Address - Phone:361-851-0000
Mailing Address - Fax:361-653-2538
Practice Address - Street 1:4621 S STAPLES ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-2605
Practice Address - Country:US
Practice Address - Phone:361-851-0000
Practice Address - Fax:361-653-2538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9599208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165159801Medicaid
TX0053LCOtherBCBS