Healthcare Provider Details

I. General information

NPI: 1477489797
Provider Name (Legal Business Name): JUAN CARLOS LUJAN LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 S HIGH ST
COLUMBUS OH
43206-3434
US

IV. Provider business mailing address

8444 N 90TH ST STE 100
SCOTTSDALE AZ
85258-4437
US

V. Phone/Fax

Practice location:
  • Phone: 380-242-4500
  • Fax: 614-745-0367
Mailing address:
  • Phone: 602-248-8886
  • Fax: 602-854-0504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP054172
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: