Healthcare Provider Details

I. General information

NPI: 1326406513
Provider Name (Legal Business Name): ADILENE CISNEROS JUAREZ MASTERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 01/30/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 E BETTERAVIA RD STE 201
SANTA MARIA CA
93454-8803
US

IV. Provider business mailing address

411 E BETTERAVIA RD STE 201
SANTA MARIA CA
93454-8803
US

V. Phone/Fax

Practice location:
  • Phone: 805-465-2553
  • Fax:
Mailing address:
  • Phone: 805-465-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12010
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3272
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15104
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: