Provider Demographics
NPI:1073215653
Name:LUCERO, MARIANA MARGO (DO, MS)
Entity Type:Individual
Prefix:
First Name:MARIANA
Middle Name:MARGO
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DO, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2880 N TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0618
Mailing Address - Country:US
Mailing Address - Phone:702-962-9546
Mailing Address - Fax:
Practice Address - Street 1:2880 N TENAYA WAY
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0618
Practice Address - Country:US
Practice Address - Phone:702-962-9546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program