Healthcare Provider Details

I. General information

NPI: 1669451803
Provider Name (Legal Business Name): ROSA JUANITA CISNEROS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 N WASHINGTON ST SUITE 22
THORNTON CO
80229-2169
US

IV. Provider business mailing address

9981 N WASHINGTON ST SUITE 22
THORNTON CO
80229-2169
US

V. Phone/Fax

Practice location:
  • Phone: 303-252-1247
  • Fax: 303-569-6078
Mailing address:
  • Phone: 303-252-1247
  • Fax: 303-569-6078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number43511
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: