Provider Demographics
NPI:1689804155
Name:LUJAN, GERMAINE THERESE
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:THERESE
Last Name:LUJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 OFFICE CT
Mailing Address - Street 2:SUITE 408
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4929
Mailing Address - Country:US
Mailing Address - Phone:505-927-7967
Mailing Address - Fax:
Practice Address - Street 1:4001 OFFICE CT
Practice Address - Street 2:SUITE 408
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4929
Practice Address - Country:US
Practice Address - Phone:505-927-7967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-19
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist