Provider Demographics
NPI:1427697507
Name:LUJAN, LESLY YARELY
Entity type:Individual
Prefix:
First Name:LESLY
Middle Name:YARELY
Last Name:LUJAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5242 DURHAM CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239-4148
Mailing Address - Country:US
Mailing Address - Phone:720-717-9868
Mailing Address - Fax:
Practice Address - Street 1:695 S COLORADO BLVD STE 10
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-8015
Practice Address - Country:US
Practice Address - Phone:720-696-9611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0000000000Medicaid