Healthcare Provider Details

I. General information

NPI: 1306119979
Provider Name (Legal Business Name): BRITINEY CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6148 W SAHARA AVE
LAS VEGAS NV
89146-3052
US

IV. Provider business mailing address

5505 GRAND RAPIDS ST
NORTH LAS VEGAS NV
89031-5099
US

V. Phone/Fax

Practice location:
  • Phone: 702-563-9183
  • Fax: 702-749-9801
Mailing address:
  • Phone: 702-563-9183
  • Fax: 702-749-9801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: