Healthcare Provider Details

I. General information

NPI: 1467156711
Provider Name (Legal Business Name): JANET CISNEROS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26565 AGOURA RD STE 200
CALABASAS CA
91302-1990
US

IV. Provider business mailing address

18546 COCQUI RD
APPLE VALLEY CA
92307-4668
US

V. Phone/Fax

Practice location:
  • Phone: 310-490-8691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number664127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: