MEDICARE: MARIA LUISA LIRA MD PA

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	208000000X	Pediatrics Physician	K9599	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	0053LC	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1669540217
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARIA LUISA LIRA MD PA

Provider Business Mailing Address
First Line	:	4621 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2605
Country	:	US
Telephone Number	:	361-851-0000
Fax Number	:	361-653-2538

Provider Business Practice Location Address
First Line	:	4621 S STAPLES ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-2605
Country	:	US
Telephone Number	:	361-851-0000
Fax Number	:	361-653-2538

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ERNESTO LIRA
Credential	:	MD
Telephone Number	:	361-851-0000

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	04/23/2015

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Directions to “MARIA LUISA LIRA MD PA ” Practice Location

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