Healthcare Provider Details

I. General information

NPI: 1629983648
Provider Name (Legal Business Name): ILIANA MARIA MARTINEZ LUGO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 LOIS ST
CLIFTON CO
81520-7514
US

IV. Provider business mailing address

436 LOIS ST
CLIFTON CO
81520-7514
US

V. Phone/Fax

Practice location:
  • Phone: 347-204-0078
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: