Healthcare Provider Details

I. General information

NPI: 1942861968
Provider Name (Legal Business Name): OLIVIA CISNEROS-MERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 BERCUT DR STE C
SACRAMENTO CA
95811-0110
US

IV. Provider business mailing address

630 BERCUT DR STE C
SACRAMENTO CA
95811-0110
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-3819
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: