Provider Demographics
NPI:1710456074
Name:PUMAREJO, LUZ M
Entity Type:Individual
Prefix:
First Name:LUZ
Middle Name:M
Last Name:PUMAREJO
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 1:279 ROSEMONT PL
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3807
Mailing Address - Country:US
Mailing Address - Phone:347-331-8400
Mailing Address - Fax:
Practice Address - Street 1:279 ROSEMONT PL
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3807
Practice Address - Country:US
Practice Address - Phone:347-331-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator