Provider Demographics
NPI:1194369520
Name:NASTER, JACQUELYN LUCERO (CPO)
Entity type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:LUCERO
Last Name:NASTER
Suffix:
Gender:F
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 DONLON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-5667
Mailing Address - Country:US
Mailing Address - Phone:805-339-0670
Mailing Address - Fax:
Practice Address - Street 1:1645 DONLON ST STE 102
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5667
Practice Address - Country:US
Practice Address - Phone:805-339-0670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA04331222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist