1720581648 NPI number — MRS. JOSEPHINE ANNE CO LUCERO PCT

Table of content: MRS. JOSEPHINE ANNE CO LUCERO PCT (NPI 1720581648)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720581648 NPI number — MRS. JOSEPHINE ANNE CO LUCERO PCT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCERO
Provider First Name:
JOSEPHINE ANNE
Provider Middle Name:
CO
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PCT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720581648
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15630 ASHGROVE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA MIRADA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90638-4906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-928-7989
Provider Business Mailing Address Fax Number:
714-266-0021

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5600 RICKENBACKER RD BLDG 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90201-6425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-263-1206
Provider Business Practice Location Address Fax Number:
323-263-8543
Provider Enumeration Date:
03/16/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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