Provider Demographics
NPI:1851783021
Name:LUCERO, FELICIA OLIVE
Entity Type:Individual
Prefix:MRS
First Name:FELICIA
Middle Name:OLIVE
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 1:541 KELSIE CT
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6043
Mailing Address - Country:US
Mailing Address - Phone:972-814-3697
Mailing Address - Fax:972-223-0951
Practice Address - Street 1:541 KELSIE CT
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6043
Practice Address - Country:US
Practice Address - Phone:972-814-3697
Practice Address - Fax:972-223-0951
Is Sole Proprietor?:No
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor