Provider Demographics
NPI:1629102389
Name:ENRIQUE LUJAN
Entity Type:Organization
Organization Name:ENRIQUE LUJAN
Other - Org Name:CHILDRENS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-689-0555
Mailing Address - Street 1:160 E REDSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5348
Mailing Address - Country:US
Mailing Address - Phone:850-689-0555
Mailing Address - Fax:850-689-3531
Practice Address - Street 1:160 E REDSTONE AVE
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5348
Practice Address - Country:US
Practice Address - Phone:850-689-0555
Practice Address - Fax:850-689-3531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty