Healthcare Provider Details

I. General information

NPI: 1891993515
Provider Name (Legal Business Name): CISNEROS CENTER OF OBSTETRICS AND GYNECOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 WASHINGTON ST SUITE 22
THORNTON CO
80229-2169
US

IV. Provider business mailing address

9981 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: DR. ROSA J CISNEROS
Title or Position: OWNER
Credential: MD
Phone: 303-252-1247