Provider Demographics
NPI:1023395100
Name:LUCERO, JULIA DIANA (NCMA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:DIANA
Last Name:LUCERO
Suffix:
Gender:F
Credentials:NCMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 MOUNT HOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURN
Mailing Address - State:OR
Mailing Address - Zip Code:97071-9060
Mailing Address - Country:US
Mailing Address - Phone:503-982-0635
Mailing Address - Fax:503-982-0627
Practice Address - Street 1:1175 MOUNT HOOD AVE
Practice Address - Street 2:
Practice Address - City:WOODBURN
Practice Address - State:OR
Practice Address - Zip Code:97071-9060
Practice Address - Country:US
Practice Address - Phone:503-982-0635
Practice Address - Fax:503-982-0627
Is Sole Proprietor?:No
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker