Healthcare Provider Details

I. General information

NPI: 1942927363
Provider Name (Legal Business Name): PATRICIA ANN LUJANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2022
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 PROFESSIONAL DR
SANTA ROSA CA
95403-3007
US

IV. Provider business mailing address

2403 PROFESSIONAL DR
SANTA ROSA CA
95403-3007
US

V. Phone/Fax

Practice location:
  • Phone: 707-544-3295
  • Fax:
Mailing address:
  • Phone: 707-544-3295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1595050125
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: