Organization
ANDREW EDWARD LUCKEY III, M.D., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW EDWARD LUCKEY III M.D. (OWNER)
(805) 577-7977
Entity
Organization
Contact information
Practice address
2650 JONES WAY, SUITE 2, SIMI VALLEY, CA 93065-1203
(805) 577-7977
(805) 577-0745
Mailing address
1301 N FAIRFAX AVE, WEST HOLLYWOOD, CA 90046-4712
(323) 876-8548
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A69654
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A69654
STATE MEDICAL LICENSE
CA
Enumeration date
02/24/2011
Last updated
02/24/2011
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