Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 12066 | WV |
NPI | 1053414268 |
---|---|
Provider Name | Mariza A Lirio |
First Address | Crab Orchard, WV 25827 |
Second Address | Crab Orchard, WV 25827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0130871000 | (05) | WV |
D49318 | (02) |