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NPI Code Detail

MEDICARE: JOCELYN DIANE LIRA

MEDICARE: JOCELYN DIANE LIRA
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1306569470
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOCELYN DIANE LIRA
Provider Business Mailing Address
First Line : 3621 MARION LN
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7579
Country : US
Telephone Number : 575-929-6200
Fax Number : 505-929-6200
Provider Business Practice Location Address
First Line : 3621 MARION LN
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7579
Country : US
Telephone Number : 575-929-6200
Fax Number : 505-929-6200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/22/2022
Last Update Date : 09/22/2022

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Directions to “ JOCELYN DIANE LIRA ” Practice Location

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