Provider Demographics
NPI:1104496009
Name:LUJANO, ALEJANDRO (BOCO)
Entity type:Individual
Prefix:
First Name:ALEJANDRO
Middle Name:
Last Name:LUJANO
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15271 COLUMBIA LN
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-2528
Mailing Address - Country:US
Mailing Address - Phone:949-510-4176
Mailing Address - Fax:951-394-7411
Practice Address - Street 1:1835 CHICAGO AVE STE A
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2309
Practice Address - Country:US
Practice Address - Phone:909-477-3117
Practice Address - Fax:909-303-9244
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC51121222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC51121OtherBOC