Healthcare Provider Details

I. General information

NPI: 1972069656
Provider Name (Legal Business Name): TAMI L CISNEROS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2019
Last Update Date: 02/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 47TH AVE # 764
SACRAMENTO CA
95824-4528
US

IV. Provider business mailing address

5735 47TH AVE # 764
SACRAMENTO CA
95824-4528
US

V. Phone/Fax

Practice location:
  • Phone: 916-643-9152
  • Fax: 916-399-2018
Mailing address:
  • Phone: 916-643-9152
  • Fax: 916-399-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number779883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: