MEDICARE: LUCERO QUINTANA

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1225976467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUCERO QUINTANA

Provider Business Mailing Address
First Line	:	1007 N 17TH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-3305
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 N 17TH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-3305
Country	:	US
Telephone Number	:	708-340-2736
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/21/2026
Last Update Date	:	03/21/2026

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Directions to “ LUCERO QUINTANA ” Practice Location

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