Healthcare Provider Details

I. General information

NPI: 1518719889
Provider Name (Legal Business Name): JESSICA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 WATT AVE STE 120
SACRAMENTO CA
95864-5027
US

IV. Provider business mailing address

591 WATT AVE STE 120
SACRAMENTO CA
95864-5027
US

V. Phone/Fax

Practice location:
  • Phone: 916-448-2050
  • Fax:
Mailing address:
  • Phone: 916-448-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: