Provider Demographics
NPI:1497395453
Name:LUCERO, TRYSHA LEE DANCY
Entity Type:Individual
Prefix:
First Name:TRYSHA
Middle Name:LEE DANCY
Last Name:LUCERO
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 1:14740 ROAD 35
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8483
Mailing Address - Country:US
Mailing Address - Phone:916-508-9624
Mailing Address - Fax:
Practice Address - Street 1:16620 40TH AVE N
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55446-2687
Practice Address - Country:US
Practice Address - Phone:563-249-5781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist