Healthcare Provider Details

I. General information

NPI: 1407091903
Provider Name (Legal Business Name): HENRY LUJAN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 03/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9195 SUNSET DR SUITE 230
MIAMI FL
33173-3488
US

IV. Provider business mailing address

12200 VISTA LN
PINECREST FL
33156-5741
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-4814
  • Fax: 305-279-1994
Mailing address:
  • Phone: 305-546-1505
  • Fax: 305-668-6653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: HENRY LUJAN
Title or Position: PHYSICIAN DIRECTOR
Credential: MD
Phone: 305-546-1505