MEDICARE: DR. ERIN MALIA CISNEROS PSY.D.

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	103T00000X	Psychologist

General Provider Information

NPI Number	:	1063664456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIN MALIA CISNEROS PSY.D.

Provider Business Mailing Address
First Line	:	3033 NUTE WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4312
Country	:	US
Telephone Number	:	808-269-4054
Fax Number	:

Provider Business Practice Location Address
First Line	:	4231 BALBOA AVE # 1465
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-5504
Country	:	US
Telephone Number	:	808-269-4054
Fax Number	:

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	01/06/2025

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