Individual
DR. DOMINIQUE LANELLE LUCKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1701 E CESAR CHAVEZ AVE, SUITE #402, LOS ANGELES, CA 90033-2464
(323) 317-9200
(323) 317-9206
Mailing address
5823 YORK BLVD, #1, LOS ANGELES, CA 90042-2634
(323) 255-3437
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
A69874
CA
207VX0000X
Obstetrics Physician
A69874
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A698740
BLUE SHIELD
CA
05
—
00A698740
—
CA
01
—
P00384423
MEDICARE RAILROAD
GA
Enumeration date
09/12/2005
Last updated
10/18/2007
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