MEDICARE: VANESSA ALICIA 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
1	225400000X	Rehabilitation Practitioner		CA

General Provider Information

NPI Number	:	1922574011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANESSA ALICIA LIRA

Provider Business Mailing Address
First Line	:	219 AVERY LN APT 10
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-7337
Country	:	US
Telephone Number	:	408-393-3471
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 AVERY LN APT 10
Second Line	:
City	:	LOS GATOS
State	:	CA
Zip	:	95032-7337
Country	:	US
Telephone Number	:	408-393-3471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/17/2018
Last Update Date	:	01/27/2026

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Directions to “ VANESSA ALICIA LIRA ” Practice Location

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