1558435305 NPI number — HUMBERTO TIJERINA M.D.

Table of content: HUMBERTO TIJERINA M.D. (NPI 1558435305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558435305 NPI number — HUMBERTO TIJERINA M.D.

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558435305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4889
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502-4889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-631-8717
Provider Business Mailing Address Fax Number:
956-630-2292

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 S COL ROWE BLVD
Provider Second Line Business Practice Location Address:
SUITE 5-A
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78501-2956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-631-8717
Provider Business Practice Location Address Fax Number:
956-630-2292
Provider Enumeration Date:
11/20/2006

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: 207T00000X , with the licence number:  G7359 , 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)

  • Identifier: 089610202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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