Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106S00000X | Behavior Technician |
NPI | 1003149550 |
---|---|
Provider Name | Melinda M Lujan |
First Address | Las Cruces, NM 88012-7686 |
Second Address | Alamogordo, NM 88310-6774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2009 |
Last Update Date | 30/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
47043 | (05) | NM |