Healthcare Provider Details

I. General information

NPI: 1972444339
Provider Name (Legal Business Name): JOSEF LUCKEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4508 N SIERRA WAY
SAN BERNARDINO CA
92407-3854
US

IV. Provider business mailing address

26571 SIMMONS WAY
HEMET CA
92544-7489
US

V. Phone/Fax

Practice location:
  • Phone: 951-252-3391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: