Provider Demographics
NPI:1417837097
Name:LUCERO, AUGUSTINE FERNANDO
Entity type:Individual
Prefix:
First Name:AUGUSTINE
Middle Name:FERNANDO
Last Name:LUCERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2151 BLAYLOCK LN NE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-9329
Mailing Address - Country:US
Mailing Address - Phone:505-974-7713
Mailing Address - Fax:
Practice Address - Street 1:2151 BLAYLOCK LN NE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-9329
Practice Address - Country:US
Practice Address - Phone:505-974-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-04
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician