Individual
EDWARD LUCERO JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
SFIDC
Contact information
Practice address
11207 GOLD BAR WAY APT 130, LAKESIDE, CA 92040-1367
(619) 368-8865
Mailing address
11207 GOLD BAR WAY APT 130, LAKESIDE, CA 92040-1367
(619) 368-8865
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
02/07/2014
Last updated
02/07/2014
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