Healthcare Provider Details

I. General information

NPI: 1417448143
Provider Name (Legal Business Name): DAPHNE TIJERO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 05/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 SUNNY PINE WAY APT D1
GREENACRES FL
33415-8972
US

IV. Provider business mailing address

714 SUNNY PINE WAY APT D1
GREENACRES FL
33415-8972
US

V. Phone/Fax

Practice location:
  • Phone: 561-310-8837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: