Healthcare Provider Details

I. General information

NPI: 1811697493
Provider Name (Legal Business Name): CLAUDIA GABRIELA CISNEROS I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 SOUTH DR STE 110
MIAMI SPRINGS FL
33166-5926
US

IV. Provider business mailing address

5101 SW 116TH AVE
MIAMI FL
33165-6029
US

V. Phone/Fax

Practice location:
  • Phone: 786-860-5161
  • Fax:
Mailing address:
  • Phone: 305-890-9271
  • 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: