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NPI Code Detail

MEDICARE: LUCERO EDITH CORDERO

MEDICARE: LUCERO EDITH CORDERO
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
1390200000XStudent in an Organized Health Care Education/Training ProgramIL

General Provider Information

NPI Number : 1881556793
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUCERO EDITH CORDERO
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE APT 2W
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-3229
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 12/01/2025

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Directions to “ LUCERO EDITH CORDERO ” Practice Location

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