Provider Demographics
NPI:1326512153
Name:MERINO DE BARQUERO, LUCIA JULIETA (SA-C)
Entity Type:Individual
Prefix:
First Name:LUCIA
Middle Name:JULIETA
Last Name:MERINO DE BARQUERO
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5126 ROYAL JASMINE PL
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-2134
Mailing Address - Country:US
Mailing Address - Phone:469-602-9404
Mailing Address - Fax:
Practice Address - Street 1:5126 ROYAL JASMINE PL
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2134
Practice Address - Country:US
Practice Address - Phone:469-602-9404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-15
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18-503246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty