Healthcare Provider Details

I. General information

NPI: 1831375641
Provider Name (Legal Business Name): MAYRA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2008
Last Update Date: 01/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

344 E JUNIPER ST
OXNARD CA
93033-3856
US

V. Phone/Fax

Practice location:
  • Phone: 805-642-7033
  • Fax: 805-642-7732
Mailing address:
  • Phone: 805-642-7033
  • Fax: 805-642-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: