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General NPI Number Information
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NPI Number | 1902076060
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Entity Type | Organization
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Legal Business Name | MARIANA E. LUCERO, M.D., CHARTERED
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Dates
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Enumeration Date | 03/05/2008
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 2132 N KANSAS AVE STE B
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City | LIBERAL
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State | KS
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Zip | 67901-2099
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Country | US
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Telephone | 620-624-7400
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Fax | 620-624-7444
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Provider Business Mailing Address
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Address Line | 2132 N KANSAS AVE STE B
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City | LIBERAL
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State | KS
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Zip | 67901-2099
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Country | US
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Telephone | 620-624-7400
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Fax | 620-624-7444
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MARIANA E. LUCERO
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Credential | M.D.
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Telephone | 620-624-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 04-28884
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License Number State | KS
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