Healthcare Provider Details

I. General information

NPI: 1194001834
Provider Name (Legal Business Name): CINDY CISNEROS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 07/25/2024
Certification Date: 07/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9829 BLUE LARKSPUR LN
MONTEREY CA
93940-6535
US

IV. Provider business mailing address

9829 BLUE LARKSPUR LN
MONTEREY CA
93940-6535
US

V. Phone/Fax

Practice location:
  • Phone: 831-647-8490
  • Fax:
Mailing address:
  • Phone: 831-647-8490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSB94028260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: