Healthcare Provider Details

I. General information

NPI: 1366310773
Provider Name (Legal Business Name): ROMARIO LUCKHOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24321 COUNTY ROAD 96
DAVIS CA
95616-9532
US

IV. Provider business mailing address

26 SIMMONS WAY APT 3
DAVIS CA
95616-2433
US

V. Phone/Fax

Practice location:
  • Phone: 530-753-1653
  • Fax:
Mailing address:
  • Phone: 530-758-2160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: