Provider Demographics
NPI:1912537523
Name:WHITE, TIJUANA DEL ROYA
Entity Type:Individual
Prefix:
First Name:TIJUANA
Middle Name:DEL ROYA
Last Name:WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 ROBESON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5500
Mailing Address - Country:US
Mailing Address - Phone:910-491-3069
Mailing Address - Fax:910-229-2143
Practice Address - Street 1:2413 ROBESON ST STE 1
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5500
Practice Address - Country:US
Practice Address - Phone:109-491-3069
Practice Address - Fax:910-229-2143
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-22
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHC5490253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care