Healthcare Provider Details

I. General information

NPI: 1962122895
Provider Name (Legal Business Name): DIANA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2022
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2805 J ST STE 230
SACRAMENTO CA
95816-4307
US

IV. Provider business mailing address

2805 J ST STE 230
SACRAMENTO CA
95816-4307
US

V. Phone/Fax

Practice location:
  • Phone: 916-497-0790
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number302546
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: