Autumn Fawn Stewart Luckey
Community Health Worker in Los Angeles, CA. Individual provider (NPI-1).
NPI number1164047510
StatusActive
Last updated in NPPESMay 8, 2025
Details
- NPI
- 1164047510
- Entity type
- Individual (NPI-1)
- Name
- Autumn Fawn Stewart Luckey
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Jun 11, 2020
- Certification date
- May 8, 2025
- Last updated
- May 8, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 172V00000X | Community Health Worker | – | – | Yes |
| 225400000X | Rehabilitation Practitioner | – | CA |
Practice location
11303 W Washington Blvd Ste 200Los Angeles, CA 90066-6003
Phone 310-482-6600 · Fax 310-313-0973
Mailing address
11303 W Washington Blvd Ste 200Los Angeles, CA 90066-6003
Phone 310-482-6600 · Fax 310-313-0973
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