Healthcare Provider Details

I. General information

NPI: 1487471801
Provider Name (Legal Business Name): CAROLINA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 WHEELOCK RD
WATSONVILLE CA
95076-9719
US

IV. Provider business mailing address

102 WHEELOCK RD
WATSONVILLE CA
95076-9719
US

V. Phone/Fax

Practice location:
  • Phone: 831-768-0941
  • Fax: 831-762-0971
Mailing address:
  • Phone: 831-768-0941
  • Fax: 831-762-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: