Provider Demographics
NPI:1194536722
Name:LUCERO, DOMINIQUE SHARMAINE
Entity type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:SHARMAINE
Last Name:LUCERO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:DOMINIQUE
Other - Middle Name:SHARMAINE
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
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:505-448-2249
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:505-448-2249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician