Provider Demographics
NPI:1598479552
Name:TIJERINA, ALBERT R
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:R
Last Name:TIJERINA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 PALM DR
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-6874
Mailing Address - Country:US
Mailing Address - Phone:760-773-6767
Mailing Address - Fax:
Practice Address - Street 1:14320 PALM DR
Practice Address - Street 2:
Practice Address - City:DESERT HOT SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92240-6874
Practice Address - Country:US
Practice Address - Phone:760-773-6767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist