MEDICARE: DONESHA L LUJAN LMT

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	225700000X	Massage Therapist	MT0012391	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MT0012391	OTHER	CO	MASSAGE THERAPIST

General Provider Information

NPI Number	:	1548684392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONESHA L LUJAN LMT

Provider Business Mailing Address
First Line	:	PO BOX 896
Second Line	:
City	:	EDGEWOOD
State	:	NM
Zip	:	87015-0896
Country	:	US
Telephone Number	:	505-286-7838
Fax Number	:	505-286-8025

Provider Business Practice Location Address
First Line	:	716 2ND ST
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-1803
Country	:	US
Telephone Number	:	505-286-7838
Fax Number	:	505-286-8025

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

Provider Enumeration Date	:	02/14/2014
Last Update Date	:	02/14/2014

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