Healthcare Provider Details

I. General information

NPI: 1841617271
Provider Name (Legal Business Name): KIMBERLY LUJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 TUCKER NE STE 474
ALBUQUERQUE NM
87131-0001
US

IV. Provider business mailing address

2400 TUCKER NE STE 474
ALBUQUERQUE NM
87131-0001
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-6130
  • Fax: 505-272-6115
Mailing address:
  • Phone: 505-272-6130
  • Fax: 505-272-6115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: