Healthcare Provider Details

I. General information

NPI: 1992400139
Provider Name (Legal Business Name): RAFAEL CISNEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2023
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

IV. Provider business mailing address

1600 DIVISADERO ST
SAN FRANCISCO CA
94143-3010
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax: 510-253-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA198290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: