Provider Demographics
NPI:1053417378
Name:LUCERO, LORETTA (RNFAC)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:RNFAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 E 30TH ST BLDG D STE 101
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-8990
Mailing Address - Country:US
Mailing Address - Phone:505-327-1400
Mailing Address - Fax:505-564-3202
Practice Address - Street 1:2300 E 30TH ST BLDG D STE 101
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8990
Practice Address - Country:US
Practice Address - Phone:505-327-1400
Practice Address - Fax:505-564-3202
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR30705163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM006488OtherBCBS
187729600OtherUS DEPT OF LABOR
850232271001OtherCHAMPUS
NM10009130OtherLOVELACE