Healthcare Provider Details

I. General information

NPI: 1255606646
Provider Name (Legal Business Name): LAURA CISNEROS LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 E BIRCH ST STE 206
BREA CA
92821-6267
US

IV. Provider business mailing address

3350 E BIRCH ST STE 206
BREA CA
92821-6267
US

V. Phone/Fax

Practice location:
  • Phone: 562-431-8822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number117159
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: