Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD2019-0932 | NM |
NPI | 1013397363 |
---|---|
Provider Name | Gina Marie Lutz |
First Address | Albuquerque, NM 87131-0001 |
Second Address | Albuquerque, NM 87110 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2015 |
Last Update Date | 03/06/2020 |