Individual
MARTHA KELLY-LUKEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7108 WERNER ST, SAN DIEGO, CA 92122-2832
(858) 518-8667
Mailing address
7108 WERNER ST, SAN DIEGO, CA 92122-2832
(858) 518-8667
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
374602460
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
310400000X
RESIDENTIAL CARE FACILITY FOR THE ELDERLY
CA
Enumeration date
09/10/2014
Last updated
09/10/2014
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