Provider Demographics
NPI:1902076060
Name:MARIANA E. LUCERO, M.D., CHARTERED
Entity Type:Organization
Organization Name:MARIANA E. LUCERO, M.D., CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUCERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-624-7400
Mailing Address - Street 1:2132 N KANSAS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-2099
Mailing Address - Country:US
Mailing Address - Phone:620-624-7400
Mailing Address - Fax:620-624-7444
Practice Address - Street 1:2132 N KANSAS AVE STE B
Practice Address - Street 2:
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-2099
Practice Address - Country:US
Practice Address - Phone:620-624-7400
Practice Address - Fax:620-624-7444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28884208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty