Provider Demographics
NPI:1982594057
Name:LIRA, VICTOR GUILLERMO (RN)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:GUILLERMO
Last Name:LIRA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1712 RICHARD CT
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:CA
Mailing Address - Zip Code:95648-2323
Mailing Address - Country:US
Mailing Address - Phone:310-951-8483
Mailing Address - Fax:
Practice Address - Street 1:1712 RICHARD CT
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:CA
Practice Address - Zip Code:95648-2323
Practice Address - Country:US
Practice Address - Phone:310-951-8483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95422519163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse