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NPI Code Detail

MEDICARE: SANDRA JULIA LUCERO PO

MEDICARE: SANDRA JULIA LUCERO PO
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
11041C0700XClinical Social Worker78624CA

General Provider Information

NPI Number : 1891161212
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA JULIA LUCERO PO
Provider Business Mailing Address
First Line : 1521 UNIVERSITY AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94703-1422
Country : US
Telephone Number : 510-981-5298
Fax Number :
Provider Business Practice Location Address
First Line : 1521 UNIVERSITY AVE
Second Line :
City : BERKELEY
State : CA
Zip : 94703-1422
Country : US
Telephone Number : 510-981-5298
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2015
Last Update Date : 09/26/2019

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Directions to “ SANDRA JULIA LUCERO PO ” Practice Location

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