Provider Demographics
NPI:1568615078
Name:LUCERO, SALINA D (MD)
Entity Type:Individual
Prefix:
First Name:SALINA
Middle Name:D
Last Name:LUCERO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2030 W MCNAB RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1002
Mailing Address - Country:US
Mailing Address - Phone:954-633-1003
Mailing Address - Fax:954-633-1024
Practice Address - Street 1:10101 FOREST HILL BLVD
Practice Address - Street 2:PATHOLOGY DEPARTMENT
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6103
Practice Address - Country:US
Practice Address - Phone:561-798-8568
Practice Address - Fax:561-798-8645
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2013-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME98173207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000677200Medicaid
FL1568615078OtherNPI
FL000677200Medicaid