Provider Demographics
NPI:1366310773
Name:LUCKHOO, ROMARIO
Entity type:Individual
Prefix:
First Name:ROMARIO
Middle Name:
Last Name:LUCKHOO
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 1:26 SIMMONS WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2433
Mailing Address - Country:US
Mailing Address - Phone:530-758-2160
Mailing Address - Fax:
Practice Address - Street 1:24321 COUNTY ROAD 96
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9532
Practice Address - Country:US
Practice Address - Phone:530-753-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA373H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist