Individual
DAVID J LUCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1100 CENTRAL AVE SE, ALBUQUERQUE, NM 87106
(505) 724-6124
Mailing address
PO BOX 26666, PHS PROVIDER ENROLLMENT, ALBUQUERQUE, NM 87125-6666
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
13080
WI
363L00000X
Nurse Practitioner
Primary
79020
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100213341
—
WI
Enumeration date
07/26/2022
Last updated
10/15/2024
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