Healthcare Provider Details

I. General information

NPI: 1023395100
Provider Name (Legal Business Name): JULIA DIANA LUCERO NCMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 MOUNT HOOD AVE
WOODBURN OR
97071-9060
US

IV. Provider business mailing address

1175 MOUNT HOOD AVE
WOODBURN OR
97071-9060
US

V. Phone/Fax

Practice location:
  • Phone: 503-982-0635
  • Fax: 503-982-0627
Mailing address:
  • Phone: 503-982-0635
  • Fax: 503-982-0627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: