Healthcare Provider Details

I. General information

NPI: 1538016597
Provider Name (Legal Business Name): SUSAN S LUCERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/11/2026
Last Update Date: 03/11/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 SUNRISE RD
SANTA FE NM
87507-4253
US

IV. Provider business mailing address

141 SUNRISE RD
SANTA FE NM
87507-4253
US

V. Phone/Fax

Practice location:
  • Phone: 505-629-2544
  • Fax:
Mailing address:
  • Phone: 505-629-2544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number26013D
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: