Healthcare Provider Details

I. General information

NPI: 1457583940
Provider Name (Legal Business Name): DAVID EDWARD CISNEROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2009
Last Update Date: 08/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 21ST ST
BAKERSFIELD CA
93301-4709
US

IV. Provider business mailing address

1018 21ST ST
BAKERSFIELD CA
93301-4709
US

V. Phone/Fax

Practice location:
  • Phone: 661-861-9967
  • Fax:
Mailing address:
  • Phone: 661-861-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: