Provider Demographics
NPI:1932573912
Name:TINAJERO, SEALTIEL ADRIAN (DO)
Entity Type:Individual
Prefix:
First Name:SEALTIEL
Middle Name:ADRIAN
Last Name:TINAJERO
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 1:147 METCALF LN
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2236
Mailing Address - Country:US
Mailing Address - Phone:435-531-6269
Mailing Address - Fax:
Practice Address - Street 1:861 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1840
Practice Address - Country:US
Practice Address - Phone:435-558-7031
Practice Address - Fax:435-558-7035
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11485112-1204207ND0101X
CODR.0061833207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty