Healthcare Provider Details

I. General information

NPI: 1891392494
Provider Name (Legal Business Name): CHRISTOPHER CISNEROS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2535 16TH ST
BAKERSFIELD CA
93301-3417
US

IV. Provider business mailing address

2342 PROFESSIONAL PKWY STE 300
SANTA MARIA CA
93455-6819
US

V. Phone/Fax

Practice location:
  • Phone: 805-979-9941
  • Fax:
Mailing address:
  • Phone: 805-979-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: