Individual
AUTUMN FAWN STEWART LUCKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
11303 W WASHINGTON BLVD STE 200, LOS ANGELES, CA 90066-6003
(310) 482-6600
(310) 313-0973
Mailing address
11303 W WASHINGTON BLVD STE 200, LOS ANGELES, CA 90066-6003
(310) 482-6600
(310) 313-0973
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
225400000X
Rehabilitation Practitioner
—
CA
Other
Enumeration date
06/11/2020
Last updated
05/08/2025
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