Healthcare Provider Details

I. General information

NPI: 1295380715
Provider Name (Legal Business Name): STEPHANIE LUJANO LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2019
Last Update Date: 08/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 7TH ST
WASCO CA
93280-1502
US

IV. Provider business mailing address

231 9TH ST
BAKERSFIELD CA
93304-1613
US

V. Phone/Fax

Practice location:
  • Phone: 661-619-5047
  • Fax: 661-758-8132
Mailing address:
  • Phone: 661-331-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number684396
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: