Provider Demographics
NPI:1003850462
Name:LUJAN, DAVINA M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVINA
Middle Name:M
Last Name:LUJAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 ROUTE 4
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96910-7110
Mailing Address - Country:US
Mailing Address - Phone:671-475-6500
Mailing Address - Fax:
Practice Address - Street 1:250 ROUTE 4
Practice Address - Street 2:SUITE 203
Practice Address - City:HAGATNA
Practice Address - State:GU
Practice Address - Zip Code:96910-7110
Practice Address - Country:US
Practice Address - Phone:671-475-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1053207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUM-1053OtherMEDICAL LICENSE
GUH104727OtherMEDICARE PTAN
GUF72038Medicare UPIN