Healthcare Provider Details

I. General information

NPI: 1831340710
Provider Name (Legal Business Name): MARIA ANGELES CISNEROS LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2008
Last Update Date: 10/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6419 CALYPSO DR
ORLANDO FL
32809-4979
US

IV. Provider business mailing address

6419 CALYPSO DR
ORLANDO FL
32809-4979
US

V. Phone/Fax

Practice location:
  • Phone: 407-247-4768
  • Fax:
Mailing address:
  • Phone: 407-247-4768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA48676
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: