Healthcare Provider Details

I. General information

NPI: 1457986168
Provider Name (Legal Business Name): MARITZA J LIRA AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2020
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

1554 PLAZA DEL AMO
TORRANCE CA
90501-5266
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95014079
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: