Organization
RAJCOMARIE LUCKRAM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS RAJCOMARIE LUCKRAM (OWNER /CAREGAVER)
(941) 743-6276
Entity
Organization
Contact information
Practice address
3166 MARINE TER, PUNTA GORDA, FL 33983-3422
(941) 743-6276
Mailing address
3166 MARINE TER, PUNTA GORDA, FL 33983-3422
(941) 743-6276
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
6906517
FL
Other
Enumeration date
05/17/2013
Last updated
05/17/2013
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