Healthcare Provider Details

I. General information

NPI: 1538901863
Provider Name (Legal Business Name): ALICE ELIZABETH CISNEROS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2024
Last Update Date: 06/07/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DR
ROSEVILLE CA
95661-3037
US

IV. Provider business mailing address

1100 ROSEVILLE PKWY APT 1025
ROSEVILLE CA
95678-4109
US

V. Phone/Fax

Practice location:
  • Phone: 916-781-1647
  • Fax:
Mailing address:
  • Phone: 951-201-0139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: