Provider Demographics
NPI:1760834493
Name:LUJAN MASSAGE
Entity Type:Organization
Organization Name:LUJAN MASSAGE
Other - Org Name:DBA GREEN LEAF MASSAGE CENTER BRIGHTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONESHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUJAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-704-9059
Mailing Address - Street 1:429 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-2101
Mailing Address - Country:US
Mailing Address - Phone:720-408-8555
Mailing Address - Fax:720-408-8555
Practice Address - Street 1:429 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2101
Practice Address - Country:US
Practice Address - Phone:720-408-8555
Practice Address - Fax:720-408-8555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012391261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty