| NPI | 1083010508 |
|---|---|
| Other Name | TIJUANA N HAWKINS |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities (Licence: VA 2090-01-001) |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2014-11-11 |