Provider Demographics
NPI:1194535344
Name:LUJAN, BAMBI (MMP)
Entity type:Individual
Prefix:
First Name:BAMBI
Middle Name:
Last Name:LUJAN
Suffix:
Gender:F
Credentials:MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 W 4TH ST STE D
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-3200
Mailing Address - Country:US
Mailing Address - Phone:719-406-0285
Mailing Address - Fax:
Practice Address - Street 1:415 W 4TH ST STE D
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-3200
Practice Address - Country:US
Practice Address - Phone:719-406-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist