Provider Demographics
NPI:1487350336
Name:LUJAN, JENINE (BEHAVIOR TECHNICIAN)
Entity type:Individual
Prefix:
First Name:JENINE
Middle Name:
Last Name:LUJAN
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 UNSER BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4660
Mailing Address - Country:US
Mailing Address - Phone:505-623-9814
Mailing Address - Fax:
Practice Address - Street 1:500 UNSER BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4660
Practice Address - Country:US
Practice Address - Phone:505-623-9814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-02
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM123713117OtherDL