Healthcare Provider Details

I. General information

NPI: 1720263528
Provider Name (Legal Business Name): DANIELLE LYNANN CISNEROS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 12/27/2021
Certification Date: 12/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39755 MURRIETA HOT SPRINGS RD STE D160
MURRIETA CA
92563-9113
US

IV. Provider business mailing address

39755 MURRIETA HOT SPRINGS RD STE D160
MURRIETA CA
92563-9113
US

V. Phone/Fax

Practice location:
  • Phone: 951-285-2282
  • Fax:
Mailing address:
  • Phone: 951-294-5393
  • Fax: 951-257-1071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number53552
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: