Provider Demographics
NPI:1538969167
Name:LUCERO, TITSYANA SALLOUM (RN)
Entity type:Individual
Prefix:
First Name:TITSYANA
Middle Name:SALLOUM
Last Name:LUCERO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TITSYANA
Other - Middle Name:
Other - Last Name:SALLOUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:201 N DOUGLAS ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4637
Practice Address - Country:US
Practice Address - Phone:310-725-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95284130163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WS0200XNursing Service ProvidersRegistered NurseSchoolGroup - Multi-Specialty