Healthcare Provider Details

I. General information

NPI: 1346112695
Provider Name (Legal Business Name): JENNIFER CISNEROS CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2025
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 RESPONSE RD STE 200
SACRAMENTO CA
95815-5255
US

IV. Provider business mailing address

7841 LA RIVIERA DR APT 299
SACRAMENTO CA
95826-1501
US

V. Phone/Fax

Practice location:
  • Phone: 916-974-2599
  • Fax:
Mailing address:
  • Phone: 760-698-0755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: