Provider Demographics
NPI:1558435305
Name:TIJERINA, HUMBERTO (MD)
Entity Type:Individual
Prefix:
First Name:HUMBERTO
Middle Name:
Last Name:TIJERINA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4889
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4889
Mailing Address - Country:US
Mailing Address - Phone:956-631-8717
Mailing Address - Fax:956-630-2292
Practice Address - Street 1:1200 S COL ROWE BLVD
Practice Address - Street 2:SUITE 5-A
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2956
Practice Address - Country:US
Practice Address - Phone:956-631-8717
Practice Address - Fax:956-630-2292
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG7359207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX089610202Medicaid
TX742425679OtherFEDERAL TAX ID NUMBER
TX614348Medicare PIN