Healthcare Provider Details

I. General information

NPI: 1518635853
Provider Name (Legal Business Name): DEYSI CAROLINA CISNEROS GUTIERREZ BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 CALIFORNIA AVE STE 100A
BAKERSFIELD CA
93309-7027
US

IV. Provider business mailing address

5909 CARROTWOOD AVE
BAKERSFIELD CA
93313-9462
US

V. Phone/Fax

Practice location:
  • Phone: 661-843-1930
  • Fax:
Mailing address:
  • Phone: 661-912-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-52473
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: