Healthcare Provider Details

I. General information

NPI: 1487503132
Provider Name (Legal Business Name): DANIELLE DOREEN LUCERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 21ST ST SE STE 9
RIO RANCHO NM
87124-4030
US

IV. Provider business mailing address

606 MESA VISTA CT SE
RIO RANCHO NM
87124-2820
US

V. Phone/Fax

Practice location:
  • Phone: 505-297-5856
  • Fax: 505-896-2958
Mailing address:
  • Phone: 505-297-5856
  • Fax: 505-297-5856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT-2025-0116
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: