Healthcare Provider Details

I. General information

NPI: 1346576428
Provider Name (Legal Business Name): MARLO YVONNE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 10/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E CHAPMAN AVE
FULLERTON CA
92831-3839
US

IV. Provider business mailing address

300 RIO GRANDE AVE
PLACENTIA CA
92870-2924
US

V. Phone/Fax

Practice location:
  • Phone: 714-680-9000
  • Fax:
Mailing address:
  • Phone: 714-933-0415
  • Fax:

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: