Provider Demographics
NPI:1922881986
Name:LUJAN, MARITZA TELLEZ
Entity Type:Individual
Prefix:
First Name:MARITZA
Middle Name:TELLEZ
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 1:251 E 200 N
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-2969
Mailing Address - Country:US
Mailing Address - Phone:435-301-7310
Mailing Address - Fax:
Practice Address - Street 1:251 E 200 N
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-2969
Practice Address - Country:US
Practice Address - Phone:435-301-7310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator