Provider Demographics
NPI:1538981493
Name:LUCERO, DIEGO A
Entity type:Individual
Prefix:
First Name:DIEGO
Middle Name:A
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 1:1181 CLAIBORNE DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1528
Mailing Address - Country:US
Mailing Address - Phone:510-862-7963
Mailing Address - Fax:
Practice Address - Street 1:1849 WILLOW PASS RD STE 400
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2581
Practice Address - Country:US
Practice Address - Phone:925-825-1081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35722124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist