Individual
STEVEN S LUSTBADER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1040 DON DIEGO AVE, #14, SANTA FE, NM 87505-3600
(505) 984-0602
Mailing address
1040 DON DIEGO AVE, #14, SANTA FE, NM 87505-3600
(505) 984-0602
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
78-56
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31047
—
NM
Enumeration date
11/28/2005
Last updated
05/23/2012
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