Provider Demographics
NPI:1184632259
Name:LUCERO, EMILY J (LMT)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:J
Last Name:LUCERO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2903 AVENIDA ALAMOSA
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-0454
Mailing Address - Country:US
Mailing Address - Phone:505-473-3053
Mailing Address - Fax:505-424-9282
Practice Address - Street 1:2903 AVENIDA ALAMOSA
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-0454
Practice Address - Country:US
Practice Address - Phone:505-473-3053
Practice Address - Fax:505-424-9282
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1270171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor