Healthcare Provider Details

I. General information

NPI: 1124405527
Provider Name (Legal Business Name): MARIA ADILENE CORONA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2361 SAMPLE AVE
CLOVIS CA
93611-5425
US

IV. Provider business mailing address

1797 SAN JOSE AVE
CLOVIS CA
93611-3078
US

V. Phone/Fax

Practice location:
  • Phone: 559-323-4502
  • Fax: 559-325-0689
Mailing address:
  • Phone: 559-790-2271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT152233
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: