Healthcare Provider Details

I. General information

NPI: 1629885009
Provider Name (Legal Business Name): LUCERO DELGADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2007 N MARTIN LUTHER KING DR
MILWAUKEE WI
53212-3152
US

IV. Provider business mailing address

2007 N MARTIN LUTHER KING DR
MILWAUKEE WI
53212-3152
US

V. Phone/Fax

Practice location:
  • Phone: 414-501-5279
  • Fax:
Mailing address:
  • Phone: 414-501-5279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberA-3937965
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: