Provider Demographics
NPI:1942797543
Name:LUCERO, RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 SAN MIGUEL DR STE 501
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7831
Mailing Address - Country:US
Mailing Address - Phone:949-720-1170
Mailing Address - Fax:949-720-1172
Practice Address - Street 1:210 S GRAND AVE STE 208
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4266
Practice Address - Country:US
Practice Address - Phone:626-914-3675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17953207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology