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NPI Code Detail

MEDICARE: VINCENT LIERAS PA

MEDICARE: VINCENT LIERAS PA
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
1363A00000XPhysician AssistantPA54581CA
2207Q00000XFamily Medicine PhysicianPA54581CA

General Provider Information

NPI Number : 1477074094
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT LIERAS PA
Provider Business Mailing Address
First Line : 30300 ANTELOPE RD APT 1826
Second Line :
City : MENIFEE
State : CA
Zip : 92584-9568
Country : US
Telephone Number : 619-203-4536
Fax Number :
Provider Business Practice Location Address
First Line : 31581 CANYON ESTATES DR
Second Line :
City : LAKE ELSINORE
State : CA
Zip : 92532-0424
Country : US
Telephone Number : 951-244-3500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/05/2017
Last Update Date : 10/21/2024

Similar Medicare Providers

1811999261 — DR. MOHAMMAD REZA DANESH M.D.
Practice Location Address:
31581 CANYON ESTATES DR
LAKE ELSINORE, CA
92532-0424
Practice Phone: 951-244-3500
Practice Fax: 951-244-3535
1376632281 — SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP, INC
Practice Location Address:
31581 CANYON ESTATES DR
LAKE ELSINORE, CA
92532-0424
Practice Phone: 951-244-3500
Practice Fax: 951-244-3535
1710242474 — SOUTHERN CALIFORNIA PRIMARY CARE CANYON LAKE URGENT & FAMILY CARE
Practice Location Address:
31581 CANYON ESTATES DR
LAKE ELSINORE, CA
92532-0424
Practice Phone: 951-244-3500
Practice Fax:
1891114609 — NAZNIN BHOLAT DDS, A DENTAL CORPORATION
Practice Location Address:
31581 CANYON ESTATES DR STE 201
LAKE ELSINORE, CA
92532-0424
Practice Phone: 805-405-1730
Practice Fax:
1518377894 — KUN SAVILLE
Practice Location Address:
31581 CANYON ESTATES DR
LAKE ELSINORE, CA
92532-0424
Practice Phone: 951-244-3500
Practice Fax: 951-344-3535
1023483591 — RYAN JACOBS PA-C
Practice Location Address:
31581 CANYON ESTATES DR
LAKE ELSINORE, CA
92532-0424
Practice Phone: 951-244-3500
Practice Fax:

Directions to “ VINCENT LIERAS PA” Practice Location

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