Healthcare Provider Details

I. General information

NPI: 1083547780
Provider Name (Legal Business Name): LUCERO PATRICIA GRUMBLES RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 DYER ST FL 3
PROVIDENCE RI
02903-3927
US

IV. Provider business mailing address

14617 CARLSON ST FL 3
POWAY CA
92064-3145
US

V. Phone/Fax

Practice location:
  • Phone: 401-203-3779
  • Fax: 855-710-6476
Mailing address:
  • Phone: 401-203-3779
  • Fax: 855-710-6476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberRN76653
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: