1194792622 NPI number — ORLANDO S. TIJERINA MD

Table of content: ORLANDO S. TIJERINA MD (NPI 1194792622)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194792622 NPI number — ORLANDO S. TIJERINA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIJERINA
Provider First Name:
ORLANDO
Provider Middle Name:
S.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TIJERINA
Provider Other First Name:
ORLANDO
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1194792622
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2308
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH PADRE ISLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78597-2308
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-671-6863
Provider Business Mailing Address Fax Number:
956-761-6863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 B E ATOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH PADRE ISLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78597-2308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-671-6863
Provider Business Practice Location Address Fax Number:
956-761-6863
Provider Enumeration Date:
03/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  L2697 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)