Provider Demographics
NPI:1538365622
Name:LIRAZAN, ESTRELLA CORTEZA I
Entity type:Individual
Prefix:MS
First Name:ESTRELLA
Middle Name:CORTEZA
Last Name:LIRAZAN
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:NH
Mailing Address - Zip Code:03263-3703
Mailing Address - Country:US
Mailing Address - Phone:603-435-6565
Mailing Address - Fax:603-435-6565
Practice Address - Street 1:40 MAIN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:NH
Practice Address - Zip Code:03263-3703
Practice Address - Country:US
Practice Address - Phone:603-435-6565
Practice Address - Fax:603-435-6565
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHREG. NO.1204156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician