Healthcare Provider Details

I. General information

NPI: 1548043342
Provider Name (Legal Business Name): ALLISON KATE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2023
Last Update Date: 08/21/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 CAMBRIDGE DR
BAKERSFIELD CA
93306-1707
US

IV. Provider business mailing address

4312 CAMBRIDGE DR
BAKERSFIELD CA
93306-1707
US

V. Phone/Fax

Practice location:
  • Phone: 661-319-4451
  • Fax:
Mailing address:
  • Phone: 661-319-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number732935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: