Provider Demographics
NPI:1376371799
Name:LUCERO, ANNAROSE (MOTR/L)
Entity type:Individual
Prefix:MRS
First Name:ANNAROSE
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1822 CANTERA ST SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-8869
Mailing Address - Country:US
Mailing Address - Phone:575-779-0593
Mailing Address - Fax:
Practice Address - Street 1:801 STEPHEN MOODY ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-1994
Practice Address - Country:US
Practice Address - Phone:505-277-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMOT3037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist