Healthcare Provider Details

I. General information

NPI: 1235015934
Provider Name (Legal Business Name): ELICIA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 E KAWEAH AVE
VISALIA CA
93292-3313
US

IV. Provider business mailing address

1388 BRIARWOOD DR
DINUBA CA
93618-3735
US

V. Phone/Fax

Practice location:
  • Phone: 559-730-7779
  • Fax:
Mailing address:
  • Phone: 559-786-4301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210145613
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: