Healthcare Provider Details

I. General information

NPI: 1124461918
Provider Name (Legal Business Name): NOELIA L TIJERINA LICENSED DIETITIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 E US HIGHWAY 83
SAN JUAN TX
78589-2900
US

IV. Provider business mailing address

2600 ORIOLE AVE
MCALLEN TX
78504-4271
US

V. Phone/Fax

Practice location:
  • Phone: 956-961-4755
  • Fax: 956-961-4764
Mailing address:
  • Phone: 956-961-4755
  • Fax: 956-961-4764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDT04621
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: