Provider Demographics
NPI:1821403502
Name:MARILOU C. LUCERO MD, INC
Entity Type:Organization
Organization Name:MARILOU C. LUCERO MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:C
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-861-3581
Mailing Address - Street 1:8301 FLORENCE AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90240-3936
Mailing Address - Country:US
Mailing Address - Phone:562-861-3581
Mailing Address - Fax:562-861-5863
Practice Address - Street 1:8301 FLORENCE AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3936
Practice Address - Country:US
Practice Address - Phone:562-861-3581
Practice Address - Fax:562-861-5863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-21
Last Update Date:2014-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31375261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84207Medicare UPIN