Provider Demographics
NPI:1205524378
Name:CRONIC, LUCERO
Entity type:Individual
Prefix:MRS
First Name:LUCERO
Middle Name:
Last Name:CRONIC
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 1:914 LARKSPUR CIR APT B
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98277-3658
Mailing Address - Country:US
Mailing Address - Phone:562-735-9581
Mailing Address - Fax:
Practice Address - Street 1:901 8TH ST
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-4107
Practice Address - Country:US
Practice Address - Phone:360-293-8421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant