MEDICARE: MISS JASMINE CISNEROS FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WM0705X	Medical-Surgical Registered Nurse	95181844	CA
2	363LF0000X	Family Nurse Practitioner	95018913	CA

General Provider Information

NPI Number	:	1063185932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS JASMINE CISNEROS FNP-C

Provider Business Mailing Address
First Line	:	5782 MARSHALL AVE
Second Line	:
City	:	BUENA PARK
State	:	CA
Zip	:	90621-2126
Country	:	US
Telephone Number	:	714-350-2769
Fax Number	:

Provider Business Practice Location Address
First Line	:	17692 BEACH BLVD STE 200
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-6810
Country	:	US
Telephone Number	:	714-847-6975
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	10/21/2021

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