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General NPI Number Information
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NPI Number | 1851780902
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Entity Type | Individual
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Provider Name | MS. AMABELLA ELSA AYERDI LUCAS
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Gender | Male
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 11404 S. BUDLONG AVE., APT.. 9
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City | GARDENA
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State | CA
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Zip | 90247-9999
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Country | US
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Telephone | 310-525-6909
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Fax | 310-819-8810
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Provider Business Mailing Address
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Address Line | 14404 S BUDLONG AVE APT. 9
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City | GARDENA
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State | CA
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Zip | 90247-2519
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Country | US
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Telephone | 310-525-6909
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Fax | 310-819-8810
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 8939
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License Number State | CA
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