Provider Demographics
NPI:1679958680
Name:AGUERO, LACEY LILLIAN (LSA)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:LILLIAN
Last Name:AGUERO
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12602 TOEPPERWEIN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:LIVE OAK
Mailing Address - State:TX
Mailing Address - Zip Code:78233-3271
Mailing Address - Country:US
Mailing Address - Phone:210-878-0090
Mailing Address - Fax:
Practice Address - Street 1:12602 TOEPPERWEIN RD STE 208
Practice Address - Street 2:
Practice Address - City:LIVE OAK
Practice Address - State:TX
Practice Address - Zip Code:78233-3271
Practice Address - Country:US
Practice Address - Phone:210-878-0090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-21
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TXSA00674246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical