Healthcare Provider Details

I. General information

NPI: 1609645779
Provider Name (Legal Business Name): AMERICA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2023
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4213 W HILLSBORO BLVD FL 33073
COCONUT CREEK FL
33073-3210
US

IV. Provider business mailing address

4213 W HILLSBORO BLVD
COCONUT CREEK FL
33073-3210
US

V. Phone/Fax

Practice location:
  • Phone: 954-573-7181
  • Fax:
Mailing address:
  • Phone: 954-573-7181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA103515
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: