Healthcare Provider Details

I. General information

NPI: 1619210259
Provider Name (Legal Business Name): MARIVEL LUNA TIJERINA RN, LBSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2013
Last Update Date: 04/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 N CAGE BLVD STE C
PHARR TX
78577-1813
US

IV. Provider business mailing address

5510 N CAGE BLVD STE C
PHARR TX
78577-1813
US

V. Phone/Fax

Practice location:
  • Phone: 956-787-7111
  • Fax: 956-781-2233
Mailing address:
  • Phone: 956-787-7111
  • Fax: 956-781-2233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number55086
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: