Provider Demographics
NPI:1811594831
Name:ACEVEDO, LUCERO M
Entity type:Individual
Prefix:
First Name:LUCERO
Middle Name:M
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6330 RUGBY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255-6938
Mailing Address - Country:US
Mailing Address - Phone:323-826-6300
Mailing Address - Fax:213-389-7993
Practice Address - Street 1:6330 RUGBY AVE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-6938
Practice Address - Country:US
Practice Address - Phone:323-826-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator