Healthcare Provider Details

I. General information

NPI: 1922677871
Provider Name (Legal Business Name): LUCERO GALLARDO-LEYVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3360 N HIGHWAY 59 STE G-K
MERCED CA
95348-9404
US

IV. Provider business mailing address

3360 N HIGHWAY 59 STE G-K
MERCED CA
95348-9404
US

V. Phone/Fax

Practice location:
  • Phone: 209-725-2125
  • Fax:
Mailing address:
  • Phone: 209-725-2125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: