Healthcare Provider Details

I. General information

NPI: 1609738202
Provider Name (Legal Business Name): LAUREN LUCERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 E 20TH ST
FARMINGTON NM
87401-8905
US

IV. Provider business mailing address

1408 8TH ST
ALAMOGORDO NM
88310-5115
US

V. Phone/Fax

Practice location:
  • Phone: 866-273-2451
  • Fax: 866-608-5560
Mailing address:
  • Phone: 866-273-2451
  • Fax: 866-608-5560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: