MEDICARE: LUCERO ELIZABETH VALENZUELA

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst	1-22-59388	AZ

General Provider Information

NPI Number	:	1588142368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCERO ELIZABETH VALENZUELA

Provider Business Mailing Address
First Line	:	1627 E WALTER DR
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5915
Country	:	US
Telephone Number	:	480-612-4912
Fax Number	:	480-801-2366

Provider Business Practice Location Address
First Line	:	1627 E WALTER DR
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-5915
Country	:	US
Telephone Number	:	480-612-4912
Fax Number	:

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

Provider Enumeration Date	:	08/02/2018
Last Update Date	:	06/09/2026

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