Healthcare Provider Details

I. General information

NPI: 1194398032
Provider Name (Legal Business Name): MARIA CRISTINA CISNEROS DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2021
Last Update Date: 07/19/2021
Certification Date: 07/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43531 10TH ST W
LANCASTER CA
93534-6005
US

IV. Provider business mailing address

34766 CAPROCK RD
AGUA DULCE CA
91390-5422
US

V. Phone/Fax

Practice location:
  • Phone: 661-839-7630
  • Fax:
Mailing address:
  • Phone: 661-607-1512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS106279
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: