Healthcare Provider Details

I. General information

NPI: 1508560715
Provider Name (Legal Business Name): ERIN LUCERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 533020, BASILONE RD.
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

BLDG. 533020 BASILONE RD.
CAMP PENDLETON NORTH CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7410
  • Fax:
Mailing address:
  • Phone: 760-725-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101283040
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101283040
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: