Provider Demographics
NPI:1821060344
Name:LUCERO, MATTHEW W (AT)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:W
Last Name:LUCERO
Suffix:
Gender:M
Credentials:AT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15754 N BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-8839
Mailing Address - Country:US
Mailing Address - Phone:623-266-8124
Mailing Address - Fax:623-322-3184
Practice Address - Street 1:15754 N BULLARD AVE
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-8839
Practice Address - Country:US
Practice Address - Phone:623-266-8124
Practice Address - Fax:623-322-3184
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist