Provider Demographics
NPI:1073311197
Name:LIRA, MELANIE ROSE
Entity type:Individual
Prefix:MRS
First Name:MELANIE
Middle Name:ROSE
Last Name:LIRA
Suffix:
Gender:
Credentials:
Other - Prefix:MS
Other - First Name:MELANIE
Other - Middle Name:ROSE
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 CAMINO DEL RIO S STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3505
Mailing Address - Country:US
Mailing Address - Phone:760-693-6848
Mailing Address - Fax:
Practice Address - Street 1:409 CAMINO DEL RIO S STE 201409
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3504
Practice Address - Country:US
Practice Address - Phone:760-693-6848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist