Provider Demographics
NPI:1184739153
Name:TIJERINA, JOSE ANTONIO (LSA)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ANTONIO
Last Name:TIJERINA
Suffix:
Gender:M
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 E 5TH ST APT 1231
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-4055
Mailing Address - Country:US
Mailing Address - Phone:512-762-7471
Mailing Address - Fax:512-899-8446
Practice Address - Street 1:1011 E 5TH ST APT 2-1231
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3996
Practice Address - Country:US
Practice Address - Phone:512-799-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXSA00148OtherLICENSE NUMBER
TX0085JROtherBCBS