Most Relevant Information
Provider Data
| NPI Number: | 1003424995 |
| Provider Name: | LAETITIA MARIE LUCERO |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 07/16/2020 |
| Last Updated: | 12/07/2020 |
Provider Practice Location
17C LOMAS DE LA CRUZ
ESPANOLA
NM
875329048
Practice Location Phone/Fax
| Phone: | 5059294848 |
| Fax: |
Provider Mailing Location
PO BOX 3994
ESPANOLA
NM
875333994
Provider Mailing Phone/Fax
| Phone: | 5059294848 |
| Fax: |