Healthcare Provider Details

I. General information

NPI: 1356576342
Provider Name (Legal Business Name): TANIA GABRIELA CISNEROS-VENTURA MFTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TANIA GABRIELA CISNEROS-VENTURA LMFT #109684

II. Dates (important events)

Enumeration Date: 05/20/2009
Last Update Date: 05/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 E. 10TH ST. SUITE L
TRACY CA
95376
US

IV. Provider business mailing address

35 E. 10TH ST. SUITE L
TRACY CA
95376
US

V. Phone/Fax

Practice location:
  • Phone: 209-637-0555
  • Fax: 209-597-5551
Mailing address:
  • Phone: 209-637-0555
  • Fax: 209-597-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number109684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: