Healthcare Provider Details

I. General information

NPI: 1639536410
Provider Name (Legal Business Name): L.CIRA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4485 IRONWOOD LN
TERRE HAUTE IN
47802-8143
US

IV. Provider business mailing address

4485 IRONWOOD LN
TERRE HAUTE IN
47802-8143
US

V. Phone/Fax

Practice location:
  • Phone: 303-880-3236
  • Fax:
Mailing address:
  • Phone: 303-880-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LORAINE CIRA
Title or Position: OWNER
Credential: RDN
Phone: 303-880-3236