Provider Demographics
NPI:1063392108
Name:LUCERO, LEONARD AGBUIS
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:AGBUIS
Last Name:LUCERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 DOVER LN
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7935
Mailing Address - Country:US
Mailing Address - Phone:209-914-9592
Mailing Address - Fax:
Practice Address - Street 1:1215 DOVER LN
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7935
Practice Address - Country:US
Practice Address - Phone:209-914-9592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)