MEDICARE: PETER AGAPAY LUCERO M.D.

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	207Q00000X	Family Medicine Physician	A41993	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A41993	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1457414856
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER AGAPAY LUCERO M.D.

Provider Business Mailing Address
First Line	:	10724 WILSHIRE BLVD
Second Line	:	APT 701
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4447
Country	:	US
Telephone Number	:	323-574-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	745 S ALVARADO ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90057-4021
Country	:	US
Telephone Number	:	213-252-2225
Fax Number	:	213-252-2244

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	03/07/2023

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