Provider Demographics
NPI:1700477122
Name:LUJANO, DANIEL PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PAUL
Last Name:LUJANO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WILLOW RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81507-2744
Mailing Address - Country:US
Mailing Address - Phone:559-802-6303
Mailing Address - Fax:
Practice Address - Street 1:410 WILLOW RIDGE CT
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81507-2744
Practice Address - Country:US
Practice Address - Phone:559-802-6303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0006617363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant