Healthcare Provider Details

I. General information

NPI: 1750602827
Provider Name (Legal Business Name): NELIE LUCERO-AGUIRRE CERTIFIED WOUND SPEC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NELIE LUCERO-AGUIRRE R.N. FNP

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S GLENDORA AVE
WEST COVINA CA
91790-4205
US

IV. Provider business mailing address

905 S GLENDORA AVE
WEST COVINA CA
91790-4205
US

V. Phone/Fax

Practice location:
  • Phone: 622-488-9940
  • Fax: 877-350-4077
Mailing address:
  • Phone: 622-488-9940
  • Fax: 877-350-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95040531
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberRN370733
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95040531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: