Healthcare Provider Details

I. General information

NPI: 1316079478
Provider Name (Legal Business Name): SANDRA NOEMI CISNEROS MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14535 SHERMAN CIR
VAN NUYS CA
91405-3087
US

IV. Provider business mailing address

10551 LANGMUIR AVE
SUNLAND CA
91040-2910
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4930
  • Fax:
Mailing address:
  • Phone: 818-408-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number112477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: