Healthcare Provider Details

I. General information

NPI: 1114086105
Provider Name (Legal Business Name): LUCAS HEALTH PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 06/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 W. MANCHESTER BLVD.
INGLEWOOD CA
90305
US

IV. Provider business mailing address

3216 W. MANCHESTER BLVD.
INGLEWOOD CA
90305
US

V. Phone/Fax

Practice location:
  • Phone: 310-412-0200
  • Fax: 310-412-0600
Mailing address:
  • Phone: 310-412-0200
  • Fax: 310-412-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ILYA VASKELL
Title or Position: OWNER
Credential:
Phone: 310-412-0200