Healthcare Provider Details

I. General information

NPI: 1063664456
Provider Name (Legal Business Name): ERIN MALIA CISNEROS PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4231 BALBOA AVE # 1465
SAN DIEGO CA
92117-5504
US

IV. Provider business mailing address

3033 NUTE WAY
SAN DIEGO CA
92117-4312
US

V. Phone/Fax

Practice location:
  • Phone: 808-269-4054
  • Fax:
Mailing address:
  • Phone: 808-269-4054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: