Provider Demographics
NPI:1689258899
Name:LUCERO, NATALIE N
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:N
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 1:14250 SOLTERRA LN
Mailing Address - Street 2:
Mailing Address - City:ADELANTO
Mailing Address - State:CA
Mailing Address - Zip Code:92301-4610
Mailing Address - Country:US
Mailing Address - Phone:909-557-4687
Mailing Address - Fax:
Practice Address - Street 1:949 KENDALL DR
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-5801
Practice Address - Country:US
Practice Address - Phone:909-886-1461
Practice Address - Fax:909-881-0581
Is Sole Proprietor?:No
Enumeration Date:2021-05-12
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70497183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician