Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 124Q00000X | Dental Hygienist | RDH32422 | CA |
NPI | 1033689963 |
---|---|
Provider Name | Lorena Lucero |
First Address | Hermosa Beach, CA 90254-3729 |
Second Address | Hermosa Beach, CA 90254-3729 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/12/2018 |
Last Update Date | 26/04/2021 |