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General NPI Number Information
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NPI Number | 1821403502
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Entity Type | Organization
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Legal Business Name | MARILOU C. LUCERO MD, INC
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Dates
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Enumeration Date | 06/21/2014
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Last Update Date | 06/21/2014
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Provider Practice Location Address
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Address Line | 8301 FLORENCE AVE SUITE 104
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City | DOWNEY
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State | CA
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Zip | 90240-3936
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Country | US
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Telephone | 562-861-3581
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Fax | 562-861-5863
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Provider Business Mailing Address
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Address Line | 8301 FLORENCE AVE SUITE 104
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City | DOWNEY
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State | CA
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Zip | 90240-3936
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Country | US
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Telephone | 562-861-3581
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Fax | 562-861-5863
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MARILOU C. LUCERO
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Credential | M.D
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Telephone | 562-861-3581
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A31375
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License Number State | CA
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