Healthcare Provider Details

I. General information

NPI: 1134389224
Provider Name (Legal Business Name): ENEDINA CISNEROS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2679 SAVIERS RD STE 230
OXNARD CA
93033-4593
US

IV. Provider business mailing address

135 MARIN RD
SANTA PAULA CA
93060-2648
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-2929
  • Fax:
Mailing address:
  • Phone: 805-754-1146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number95583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: