Individual
PETER M LIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1550 S ANAHEIM BLVD, SUITE G, ANAHEIM, CA 92805-6218
(562) 355-0279
Mailing address
1550 SO ANAHEIM BLVD, SUITE G, ANAHEIM, CA 92805-6218
(714) 635-1401
(714) 635-1422
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
CO0003156
CA
1744P3200X
Prosthetics Case Management
Primary
CO3156
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CO0003156
ABC CERTIFICATE
CA
05
—
X60007611
—
CA
Enumeration date
05/03/2006
Last updated
06/17/2011
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