Healthcare Provider Details

I. General information

NPI: 1932051133
Provider Name (Legal Business Name): DJARIS CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2026
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 S LEES SUMMIT RD
INDEPENDENCE MO
64055-1937
US

IV. Provider business mailing address

2400 S LEES SUMMIT RD
INDEPENDENCE MO
64055-1937
US

V. Phone/Fax

Practice location:
  • Phone: 816-986-0444
  • Fax:
Mailing address:
  • Phone: 816-986-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number1999134831
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: