MEDICARE: VIRGINIA LUCERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP1600X	Pastoral Counselor

General Provider Information

NPI Number	:	1184479909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIRGINIA LUCERO

Provider Business Mailing Address
First Line	:	285 MOSS ST UNIT 5
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-2150
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 MOSS ST UNIT 5
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-2150
Country	:	US
Telephone Number	:	619-253-7972
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2024
Last Update Date	:	04/23/2024

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Directions to “ VIRGINIA LUCERO ” Practice Location

Language	Start Address	Practice Location

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