Individual
CARLOS DE LIRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2450 S ATLANTIC BLVD STE 101, COMMERCE, CA 90040-1200
(323) 318-9960
(323) 780-3211
Mailing address
2450 S ATLANTIC BLVD STE 101, COMMERCE, CA 90040-1200
(323) 318-9960
(323) 780-3211
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#95-2633765
MEDI-CAL
CA
Enumeration date
10/25/2012
Last updated
10/25/2012
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