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Individual
MAX T TIJERINO
Active
Individual
MAX T TIJERINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA10936
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
365425301
—
TX
01
—
75-2616977-039
TRICARE
TX
01
—
75-2616977-123
TRICARE
TX
01
—
88117MA
BCBS
TX
01
—
P01762498
RAIL ROAD MEDICARE
TX
Enumeration date
10/18/2016
Last updated
02/10/2017
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