Healthcare Provider Details

I. General information

NPI: 1770355018
Provider Name (Legal Business Name): KIARATIVE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1554 PLAZA DEL AMO
TORRANCE CA
90501-5266
US

IV. Provider business mailing address

553 N PACIFIC COAST HWY STE B515
REDONDO BEACH CA
90277-2163
US

V. Phone/Fax

Practice location:
  • Phone: 949-735-2586
  • Fax: 949-649-7043
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARITZA J LIRA
Title or Position: CEO
Credential: NP
Phone: 949-735-2586