Provider Demographics
NPI:1619210259
Name:TIJERINA, MARIVEL LUNA (RN, LBSW)
Entity Type:Individual
Prefix:
First Name:MARIVEL
Middle Name:LUNA
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:RN, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5510 N CAGE BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-1813
Mailing Address - Country:US
Mailing Address - Phone:956-787-7111
Mailing Address - Fax:956-781-2233
Practice Address - Street 1:5510 N CAGE BLVD STE C
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-1813
Practice Address - Country:US
Practice Address - Phone:956-787-7111
Practice Address - Fax:956-781-2233
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55086171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator