Individual
IDA P. LUCERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
315 S. HUDSON ST, STE 6, SILVER CITY, NM 88061
(575) 388-4412
(575) 534-1170
Mailing address
530 DE MOSS ST, LORDSBURG, NM 88045
(575) 542-8384
(575) 542-2388
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
18677037
—
NM
Enumeration date
10/12/2009
Last updated
08/25/2020
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