Healthcare Provider Details

I. General information

NPI: 1447276266
Provider Name (Legal Business Name): JEANETTE LOPEZ CISNEROS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 04/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 E ALISAL ST SUITE 201
SALINAS CA
93905-2516
US

IV. Provider business mailing address

1615 BUNKER HILL WAY SUITE 100
SALINAS CA
93906-6013
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8800
  • Fax: 831-422-9312
Mailing address:
  • Phone: 831-769-1304
  • Fax: 831-757-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG57345
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: