Provider Demographics
NPI:1619958774
Name:LUJAN, NATASHA J (MD)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:J
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 1:510 N GUADALUPE ST STE C1-C2
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-6510
Mailing Address - Country:US
Mailing Address - Phone:505-913-4660
Mailing Address - Fax:
Practice Address - Street 1:510 N GUADALUPE ST STE C1-C2
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-6510
Practice Address - Country:US
Practice Address - Phone:505-913-4660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2001-68207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine