Provider Demographics
NPI:1457414856
Name:LUCERO, PETER AGAPAY (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:AGAPAY
Last Name:LUCERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10724 WILSHIRE BLVD
Mailing Address - Street 2:APT 701
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4447
Mailing Address - Country:US
Mailing Address - Phone:323-574-9181
Mailing Address - Fax:
Practice Address - Street 1:745 S ALVARADO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4021
Practice Address - Country:US
Practice Address - Phone:213-252-2225
Practice Address - Fax:213-252-2244
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA41993207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41993OtherMEDICAL LICENSE
CAA41993OtherMEDICAL LICENSE