MEDICARE: ALEJANDRO LUJANO BOCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Z00000X	Orthotist	C51121	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C51121	OTHER	CA	BOC

General Provider Information

NPI Number	:	1104496009
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEJANDRO LUJANO BOCO

Provider Business Mailing Address
First Line	:	15271 COLUMBIA LN
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-2528
Country	:	US
Telephone Number	:	949-510-4176
Fax Number	:	951-394-7411

Provider Business Practice Location Address
First Line	:	1835 CHICAGO AVE STE A
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92507-2309
Country	:	US
Telephone Number	:	909-477-3117
Fax Number	:	909-303-9244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2021
Last Update Date	:	07/01/2021

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