Healthcare Provider Details

I. General information

NPI: 1568653053
Provider Name (Legal Business Name): LUCAS HEALTH PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 CRENSHAW BLVD
INGLEWOOD CA
90303-2835
US

IV. Provider business mailing address

11225 CRENSHAW BLVD
INGLEWOOD CA
90303-2835
US

V. Phone/Fax

Practice location:
  • Phone: 310-412-0200
  • Fax: 424-800-2082
Mailing address:
  • Phone: 310-412-0200
  • Fax: 424-800-2082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number06000074
License Number StateCA

VIII. Authorized Official

Name: MR. ANDRE BAGRAMYAN
Title or Position: COO
Credential:
Phone: 310-412-0200