Healthcare Provider Details

I. General information

NPI: 1619552148
Provider Name (Legal Business Name): MS. JOANNA MARIE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 03/16/2021
Certification Date: 03/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21600 OXNARD ST STE 1030
WOODLAND HILLS CA
91367-5085
US

IV. Provider business mailing address

570 KNOLLVIEW CT APT 1003
PALMDALE CA
93551-4222
US

V. Phone/Fax

Practice location:
  • Phone: 877-206-1009
  • Fax:
Mailing address:
  • Phone: 915-731-7865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: