Provider Demographics
NPI:1851780902
Name:LUCAS, AMABELLA ELSA AYERDI
Entity Type:Individual
Prefix:MS
First Name:AMABELLA ELSA
Middle Name:AYERDI
Last Name:LUCAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14404 S BUDLONG AVE
Mailing Address - Street 2:APT. 9
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-2519
Mailing Address - Country:US
Mailing Address - Phone:310-525-6909
Mailing Address - Fax:310-819-8810
Practice Address - Street 1:11404 S. BUDLONG AVE.,
Practice Address - Street 2:APT.. 9
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-9999
Practice Address - Country:US
Practice Address - Phone:310-525-6909
Practice Address - Fax:310-819-8810
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-13
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8939225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist