Healthcare Provider Details

I. General information

NPI: 1649974742
Provider Name (Legal Business Name): ADAN NOEL TIJERINA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST # MS 29C269
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

3471 LAKE AUSTIN BLVD APT E
AUSTIN TX
78703-5557
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-1695
  • Fax:
Mailing address:
  • Phone: 830-480-4052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: