Healthcare Provider Details

I. General information

NPI: 1699245217
Provider Name (Legal Business Name): HENRY MAURICIO TIJERINO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 THEATRE DR
PASO ROBLES CA
93446-9604
US

IV. Provider business mailing address

10949 DUNCAN AVE
LYNWOOD CA
90262
US

V. Phone/Fax

Practice location:
  • Phone: 805-227-4304
  • Fax:
Mailing address:
  • Phone: 562-221-1573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number79797
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: