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Individual

DR. ANDREW LUCKEY III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
2650 JONES WAY, SUITE 2, SIMI VALLEY, CA 93065-1203
(805) 577-7977
(805) 577-0745
Mailing address
1189 SWALLOW LN, STE 201, SIMI VALLEY, CA 93065-3157
(805) 577-7977
(805) 577-0745

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A69654
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
A69654
STATE LICENSE
CA
Enumeration date
01/22/2007
Last updated
04/21/2016
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