Provider Demographics
NPI:1275955353
Name:LUCERO, MONICA NICOLE (DOM)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:NICOLE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 LUCERO LN
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-6884
Mailing Address - Country:US
Mailing Address - Phone:505-550-5358
Mailing Address - Fax:
Practice Address - Street 1:306 LUCERO LN
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-6884
Practice Address - Country:US
Practice Address - Phone:505-550-5358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1134171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist