Provider Demographics
NPI:1750602827
Name:LUCERO-AGUIRRE, NELIE (CERTIFIED WOUND SPEC)
Entity type:Individual
Prefix:
First Name:NELIE
Middle Name:
Last Name:LUCERO-AGUIRRE
Suffix:
Gender:F
Credentials:CERTIFIED WOUND SPEC
Other - Prefix:
Other - First Name:NELIE
Other - Middle Name:
Other - Last Name:LUCERO-AGUIRRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:9808 VENICE BLVD
Mailing Address - Street 2:STE. 600
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2732
Mailing Address - Country:US
Mailing Address - Phone:622-488-9940
Mailing Address - Fax:
Practice Address - Street 1:9808 VENICE BLVD
Practice Address - Street 2:STE. 600
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-2732
Practice Address - Country:US
Practice Address - Phone:622-488-9940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN370733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist