Provider Demographics
NPI:1174358501
Name:LUCERO, LUIS E (PHD)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:E
Last Name:LUCERO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N. BRAND BLVD.
Mailing Address - Street 2:STE 638
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:213-448-2835
Mailing Address - Fax:213-448-2835
Practice Address - Street 1:450 N. BRAND BLVD.
Practice Address - Street 2:STE 638
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203
Practice Address - Country:US
Practice Address - Phone:213-448-2835
Practice Address - Fax:213-448-2835
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical