Healthcare Provider Details

I. General information

NPI: 1326591652
Provider Name (Legal Business Name): JUSTINE LEA TIJERINA CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2016
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11440 MATZKE RD
CYPRESS TX
77429-5015
US

IV. Provider business mailing address

67 S HIGLEY RD STE 103-477
GILBERT AZ
85296-1166
US

V. Phone/Fax

Practice location:
  • Phone: 361-944-7021
  • Fax:
Mailing address:
  • Phone: 361-944-7021
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number111702
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: