Basic Information
| Provider Information | |||||||||
| NPI: | 1821069030 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANCAYA-LUJAN | ||||||||
| FirstName: | DORA | ||||||||
| MiddleName: | V. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2147 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339022147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394243123 | ||||||||
| FaxNumber: | 2394244041 | ||||||||
| Practice Location | |||||||||
| Address1: | 636 DEL PRADO BLVD S | ||||||||
| Address2: | |||||||||
| City: | CAPE CORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339902668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2394243123 | ||||||||
| FaxNumber: | 2394244041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/27/2006 | ||||||||
| LastUpdateDate: | 12/11/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/11/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME109680 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | ME109680 | FL | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P00969463 | 01 | FL | RR MEDICARE | OTHER | 14F03 | 01 | FL | BCBSFL | OTHER | 9524087. | 01 | FL | AETNA | OTHER | 003825700 | 05 | FL | MEDICAID | 3458947 | 01 | FL | CIGNA | OTHER | AQ117Z | 01 | FL | MEDICARE PTAN | OTHER |