Active NPI
Perry Gerard Lucero
- Dentist
- La Verne, CA
National Provider Identifier
1700046232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 034374
- Practice address
- 2210 3Rd St
La Verne, CA 91750-4917 - Phone
- (909) 593-4628
- Fax
- (909) 593-4125
- NPI assigned
- Jun 9, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 034374 | CA | Primary |
Addresses
Primary practice location
2210 3Rd St
La Verne, CA 91750-4917
Mailing address
2210 3Rd St
La Verne, CA 91750-4917
Phone (909) 593-4628
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jul 1, 2016 through Jul 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 034374 | CA | MD | Dentist |
| 34374 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1212969600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212969600000",
"number": "1700046232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2210 3RD ST",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917504917",
"telephone_number": "909-593-4628",
"fax_number": "909-593-4125"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2210 3RD ST",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917504917",
"telephone_number": "909-593-4628",
"fax_number": "909-593-4125"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCERO",
"first_name": "PERRY",
"middle_name": "GERARD",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-09",
"last_updated": "2008-06-09",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CA",
"license": "034374",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.