MEDICARE: THELMA LOPEZ-LIRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	K0115	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0061BK	OTHER	TX	BCBS OF TX

General Provider Information

NPI Number	:	1437125036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THELMA LOPEZ-LIRA MD

Provider Business Mailing Address
First Line	:	PO BOX 271402
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78427
Country	:	US
Telephone Number	:	361-980-1201
Fax Number	:	361-980-1401

Provider Business Practice Location Address
First Line	:	4525 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2603
Country	:	US
Telephone Number	:	361-980-1201
Fax Number	:	361-980-1401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	10/29/2013

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Practice Fax: 361-980-1401

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