MEDICARE: NOELIA L TIJERINA LICENSED DIETITIAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	DT04621	TX

General Provider Information

NPI Number	:	1124461918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOELIA L TIJERINA LICENSED DIETITIAN

Provider Business Mailing Address
First Line	:	2600 ORIOLE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4271
Country	:	US
Telephone Number	:	956-961-4755
Fax Number	:	956-961-4764

Provider Business Practice Location Address
First Line	:	302 E US HIGHWAY 83
Second Line	:
City	:	SAN JUAN
State	:	TX
Zip	:	78589-2900
Country	:	US
Telephone Number	:	956-961-4755
Fax Number	:	956-961-4764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	04/10/2013

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