Provider Demographics
NPI:1639889660
Name:CANADA, NOOR LUCERO
Entity Type:Individual
Prefix:
First Name:NOOR
Middle Name:LUCERO
Last Name:CANADA
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 1:1250 N INDIAN HILL BLVD APT 23
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3856
Mailing Address - Country:US
Mailing Address - Phone:909-677-9454
Mailing Address - Fax:
Practice Address - Street 1:1250 N INDIAN HILL BLVD APT 23
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3856
Practice Address - Country:US
Practice Address - Phone:909-677-9454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula