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NPI Code Detail

MEDICARE: JACQUELYN V LACERA MD

MEDICARE: JACQUELYN V LACERA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA76173CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11730180415OTHERGROUP NPI #

General Provider Information

NPI Number : 1063499200
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN V LACERA MD
Provider Business Mailing Address
First Line : 21634 RETREAT PKWY
Second Line :
City : CORONA
State : CA
Zip : 92883-6100
Country : US
Telephone Number : 951-493-6906
Fax Number : 951-826-8157
Provider Business Practice Location Address
First Line : 21634 RETREAT PKWY
Second Line :
City : CORONA
State : CA
Zip : 92883-6100
Country : US
Telephone Number : 951-493-6906
Fax Number : 951-826-8157
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/29/2005
Last Update Date : 07/30/2025

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Directions to “ JACQUELYN V LACERA MD” Practice Location

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