Healthcare Provider Details

I. General information

NPI: 1821193426
Provider Name (Legal Business Name): MR. SIGIFREDO TIJERINA JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST STE 100B
SANTA ANA CA
92701-3630
US

IV. Provider business mailing address

204 S OHIO ST APT C
ANAHEIM CA
92805-3697
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6650
  • Fax: 714-571-5659
Mailing address:
  • Phone: 714-480-6650
  • Fax: 714-571-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: