Healthcare Provider Details

I. General information

NPI: 1114885183
Provider Name (Legal Business Name): ADONISE STEVEN LUCERO CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 GOLD AVE SW STE 1060
ALBUQUERQUE NM
87102-3263
US

IV. Provider business mailing address

400 GOLD AVE SW STE 1060
ALBUQUERQUE NM
87102-3263
US

V. Phone/Fax

Practice location:
  • Phone: 305-450-9651
  • Fax:
Mailing address:
  • Phone: 305-450-9651
  • Fax: 305-418-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number1983
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: