Provider Demographics
NPI:1356502793
Name:STEWART, CARMEN LUCATERO
Entity Type:Individual
Prefix:MRS
First Name:CARMEN
Middle Name:LUCATERO
Last Name:STEWART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8376 HERCULES ST
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2902
Mailing Address - Country:US
Mailing Address - Phone:619-698-4471
Mailing Address - Fax:
Practice Address - Street 1:8376 HERCULES ST
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2902
Practice Address - Country:US
Practice Address - Phone:619-698-4471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator