Healthcare Provider Details

I. General information

NPI: 1013888015
Provider Name (Legal Business Name): LUCERO SOSA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BRISTOL ST
COSTA MESA CA
92626-5996
US

IV. Provider business mailing address

PO BOX 2045
WESTMINSTER CA
92684-2045
US

V. Phone/Fax

Practice location:
  • Phone: 714-850-8408
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number131232
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: