Healthcare Provider Details

I. General information

NPI: 1184423204
Provider Name (Legal Business Name): GISELLE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 CAPITOL ST
VALLEJO CA
94590-5721
US

IV. Provider business mailing address

1840 CAPITOL ST
VALLEJO CA
94590-5721
US

V. Phone/Fax

Practice location:
  • Phone: 510-593-5496
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: