Healthcare Provider Details

I. General information

NPI: 1265950786
Provider Name (Legal Business Name): GLADYS J LUCERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12411 SLAUSON AVE UNIT H
WHITTIER CA
90606
US

IV. Provider business mailing address

12411 SLAUSON AVE UNIT H
WHITTIER CA
90606
US

V. Phone/Fax

Practice location:
  • Phone: 562-693-6544
  • Fax:
Mailing address:
  • Phone: 562-693-5449
  • Fax: 562-693-5469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number4444
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: