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General NPI Number Information
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NPI Number | 1801501838
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Entity Type | Individual
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Provider Name | MARA TIJERINA
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Gender | Female
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Dates
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Enumeration Date | 01/13/2023
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Last Update Date | 04/29/2025
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Provider Practice Location Address
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Address Line | 10710 N TORREY PINES RD # MS 116
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City | LA JOLLA
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State | CA
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Zip | 92037-1035
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Country | US
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Telephone | 858-554-7007
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Fax |
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Provider Business Mailing Address
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Address Line | 10790 RANCHO BERNARDO RD
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City | SAN DIEGO
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State | CA
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Zip | 92127-5705
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Country | US
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Telephone | 619-849-4469
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 4704317559
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95032521
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License Number State | CA
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