Healthcare Provider Details

I. General information

NPI: 1235505074
Provider Name (Legal Business Name): REBECCA CISNEROS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2015
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 ROGERS AVE
FORT SMITH AR
72903
US

IV. Provider business mailing address

403 KENDALL DR
LAMAR CO
81052-3953
US

V. Phone/Fax

Practice location:
  • Phone: 479-314-6000
  • Fax:
Mailing address:
  • Phone: 719-336-6767
  • Fax: 719-336-7217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberDR.0067511
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberE-11751
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0067511
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: