Provider Demographics
NPI:1790089738
Name:LUJAN, MARIA YESENIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:YESENIA
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 1:430 FALLBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91320-4929
Mailing Address - Country:US
Mailing Address - Phone:818-274-2008
Mailing Address - Fax:
Practice Address - Street 1:19231 VICTORY BLVD STE 110
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-6321
Practice Address - Country:US
Practice Address - Phone:818-708-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT78371106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist