Healthcare Provider Details

I. General information

NPI: 1841882867
Provider Name (Legal Business Name): KENIA TIJERA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 09/27/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CORPORATE CENTER DIVE SUITE 350
MONTERREY PARK CA
91754
US

IV. Provider business mailing address

900 CORPORATE CENTER DIVE SUITE 350
MONTERREY PARK CA
91754
US

V. Phone/Fax

Practice location:
  • Phone: 323-526-4016
  • Fax: 323-526-4096
Mailing address:
  • Phone: 323-526-4016
  • Fax: 323-526-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: