Healthcare Provider Details

I. General information

NPI: 1346822103
Provider Name (Legal Business Name): VIVIANA TIJERINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10162 SANDYGLEN
SAN ANTONIO TX
78240-2573
US

IV. Provider business mailing address

10162 SANDYGLEN
SAN ANTONIO TX
78240-2573
US

V. Phone/Fax

Practice location:
  • Phone: 210-643-2132
  • Fax:
Mailing address:
  • Phone: 210-643-2132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1026755
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: