Provider Demographics
NPI:1770322554
Name:TIJERINA, RUDY (DO)
Entity type:Individual
Prefix:
First Name:RUDY
Middle Name:
Last Name:TIJERINA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 FOREST BAY CT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2171
Mailing Address - Country:US
Mailing Address - Phone:713-805-0753
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL AVE STE 400
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5595
Practice Address - Country:US
Practice Address - Phone:903-236-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program