Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 04331 | CA |
Y | 222Z00000X | Podiatrist | 04331 | CA |
N | 224P00000X | Prosthetist | 04331 | CA |
NPI | 1194369520 |
---|---|
Provider Name | Mrs. Jacquelyn Lucero Naster |
First Address | Ventura, CA 93003-5667 |
Second Address | Ventura, CA 93003-5667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2019 |
Last Update Date | 29/10/2019 |