Healthcare Provider Details

I. General information

NPI: 1144961285
Provider Name (Legal Business Name): RICHARD LUCERO CATABONA JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

2512 CHAMBERS RD STE 104
TUSTIN CA
92780-6950
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7890
  • Fax:
Mailing address:
  • Phone: 818-428-5994
  • Fax: 551-236-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number21779
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: