Provider Demographics
NPI:1124461918
Name:TIJERINA, NOELIA L (LICENSED DIETITIAN)
Entity type:Individual
Prefix:
First Name:NOELIA
Middle Name:L
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:LICENSED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 ORIOLE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4271
Mailing Address - Country:US
Mailing Address - Phone:956-961-4755
Mailing Address - Fax:956-961-4764
Practice Address - Street 1:302 E US HIGHWAY 83
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:TX
Practice Address - Zip Code:78589-2900
Practice Address - Country:US
Practice Address - Phone:956-961-4755
Practice Address - Fax:956-961-4764
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT04621133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered