Provider Demographics
NPI:1245761873
Name:PEREZ-LUJAN, LEVI
Entity Type:Individual
Prefix:
First Name:LEVI
Middle Name:
Last Name:PEREZ-LUJAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4019 PATTERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89104-5243
Mailing Address - Country:US
Mailing Address - Phone:702-848-8515
Mailing Address - Fax:
Practice Address - Street 1:4019 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89104-5243
Practice Address - Country:US
Practice Address - Phone:702-848-8515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0802106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist