Healthcare Provider Details

I. General information

NPI: 1215744867
Provider Name (Legal Business Name): LUCERO RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 M ST APT 11
MERCED CA
95348-2718
US

IV. Provider business mailing address

3306 M ST APT 11
MERCED CA
95348-2718
US

V. Phone/Fax

Practice location:
  • Phone: 209-631-6840
  • Fax:
Mailing address:
  • Phone: 209-631-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: