Individual
MATIAS B LUCERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
21371 SAN SIMEON WAY APT 305, MIAMI, FL 33179-2095
(954) 907-6195
Mailing address
21371 SAN SIMEON WAY APT 305, MIAMI, FL 33179-2095
(954) 907-6195
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 11934
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OTA 11934
DEPARTMENT OF HEALTH
FL
Enumeration date
08/30/2012
Last updated
08/16/2023
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