Healthcare Provider Details

I. General information

NPI: 1609370303
Provider Name (Legal Business Name): ANA ESTHER CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date: 09/04/2019
Reactivation Date: 08/25/2020

III. Provider practice location address

26780 SW 142ND AVE APT 202
HOMESTEAD FL
33032-5420
US

IV. Provider business mailing address

26780 SW 142ND AVE APT 202
HOMESTEAD FL
33032-5420
US

V. Phone/Fax

Practice location:
  • Phone: 786-286-1339
  • Fax:
Mailing address:
  • Phone: 786-286-1339
  • 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: