Healthcare Provider Details

I. General information

NPI: 1538365622
Provider Name (Legal Business Name): MS. ESTRELLA CORTEZA LIRAZAN I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 MAIN ST
PITTSFIELD NH
03263-3703
US

IV. Provider business mailing address

40 MAIN ST
PITTSFIELD NH
03263-3703
US

V. Phone/Fax

Practice location:
  • Phone: 603-435-6565
  • Fax: 603-435-6565
Mailing address:
  • Phone: 603-435-6565
  • Fax: 603-435-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberREG. NO.1204
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: