Provider Demographics
NPI:1801233119
Name:LUJAN, JAY (ATP,RRTS)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:LUJAN
Suffix:
Gender:M
Credentials:ATP,RRTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 BARRANCA DR
Mailing Address - Street 2:SUITE 700
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-5004
Mailing Address - Country:US
Mailing Address - Phone:915-591-3130
Mailing Address - Fax:915-591-3136
Practice Address - Street 1:1111 BARRANCA DR
Practice Address - Street 2:SUITE 700
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-5004
Practice Address - Country:US
Practice Address - Phone:915-591-3130
Practice Address - Fax:915-591-3136
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other