Healthcare Provider Details

I. General information

NPI: 1225959216
Provider Name (Legal Business Name): LUCERO ALICIA OLAYO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

5005 TEXAS ST
SAN DIEGO CA
92108-3721
US

IV. Provider business mailing address

PO BOX 5306
SAN DIEGO CA
92165-5306
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-0727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: