Healthcare Provider Details

I. General information

NPI: 1225922479
Provider Name (Legal Business Name): TIARA LUJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2025
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 CANDELARIA RD NE
ALBUQUERQUE NM
87107-1956
US

IV. Provider business mailing address

1345 CHEROKEE RD NW
ALBUQUERQUE NM
87107-2719
US

V. Phone/Fax

Practice location:
  • Phone: 505-457-2867
  • Fax:
Mailing address:
  • Phone: 505-730-2175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberRN-83798
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: