Healthcare Provider Details

I. General information

NPI: 1912390915
Provider Name (Legal Business Name): RONNIE M SISNEROS COTA/L
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2015
Last Update Date: 03/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3534 SIERRA PRADO CT 3534 SIERRA PRADO CT
LAS CRUCES NM
88012-0722
US

IV. Provider business mailing address

3534 SIERRA PRADO CT 3534 SIERRA PRADO CT
LAS CRUCES NM
88012-0722
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-3684
  • Fax:
Mailing address:
  • Phone: 575-636-3684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number2335
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: