Provider Demographics
NPI:1548408685
Name:LUJAN, RICHARD PHIL (RN)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:PHIL
Last Name:LUJAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 COAL AVE. SW
Mailing Address - Street 2:APT# 170
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102
Mailing Address - Country:US
Mailing Address - Phone:505-203-3369
Mailing Address - Fax:
Practice Address - Street 1:701 COAL AVE SW
Practice Address - Street 2:APT# 170
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3068
Practice Address - Country:US
Practice Address - Phone:505-203-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR67334163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse