Individual
LUCYANA TANUWIDJAJA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6948 S SYRACUSE CT, CENTENNIAL, CO 80112-1230
(720) 404-6249
Mailing address
6948 S SYRACUSE CT, CENTENNIAL, CO 80112-1230
(720) 404-6249
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
08/09/2021
Last updated
08/09/2021
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