Provider Demographics
NPI:1598155368
Name:LUJAN, BERNADETTE J (DOM)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:J
Last Name:LUJAN
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2183
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NM
Mailing Address - Zip Code:87701-2183
Mailing Address - Country:US
Mailing Address - Phone:505-454-0003
Mailing Address - Fax:505-454-0003
Practice Address - Street 1:338 SANTA ANA ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-3758
Practice Address - Country:US
Practice Address - Phone:505-454-0003
Practice Address - Fax:505-910-4665
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-30
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1142171100000X
NMDOM1141171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist