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1043407778 NPI number — ROBERTA ALBINA LUCERO MPT ATC

NPI Number: 1043407778
Health Care Provider/Practitioner: ROBERTA ALBINA LUCERO MPT ATC

Information about “1043407778” NPI (ROBERTA ALBINA LUCERO MPT ATC) exists in 1043407778 in HTML format HTML  |  1043407778 in plain Text format TXT  |  1043407778 in PDF (Portable Document Format) PDF  |  1043407778 in an XML format XML  formats.

NPI Number : 1043407778 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043407778",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUCERO",
    "FirstName": "ROBERTA",
    "MiddleName": "ALBINA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MPT ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROYBAL",
    "OtherFirstName": "ROBERTA",
    "OtherMiddleName": "ALBINA",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "ATC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "624 UNIVERSITY AVE",
    "SecondLineMailingAddress": "STE 100",
    "MailingAddressCityName": "LAS VEGAS",
    "MailingAddressStateName": "NM",
    "MailingAddressPostalCode": "87701-4252",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "575-472-8946",
    "MailingAddressFaxNumber": "575-472-8948",
    "FirstLinePracticeLocationAddress": "624 UNIVERSITY AVE",
    "SecondLinePracticeLocationAddress": "STE 100",
    "PracticeLocationAddressCityName": "LAS VEGAS",
    "PracticeLocationAddressStateName": "NM",
    "PracticeLocationAddressPostalCode": "87701-4252",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "505-454-1078",
    "PracticeLocationAddressFaxNumber": "505-454-1164",
    "EnumerationDate": "09/26/2007",
    "LastUpdateDate": "10/25/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "225100000X",
        "TaxonomyName": "Physical Therapist",
        "LicenseNumber": "3441",
        "LicenseNumberStateCode": "NM",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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