Healthcare Provider Details

I. General information

NPI: 1710522321
Provider Name (Legal Business Name): SONIA MARIA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 N DURANGO DR STE 110
LAS VEGAS NV
89149-3939
US

IV. Provider business mailing address

6200 N DURANGO DR STE 110
LAS VEGAS NV
89149-3939
US

V. Phone/Fax

Practice location:
  • Phone: 702-577-2606
  • Fax: 702-710-6023
Mailing address:
  • Phone: 702-577-2606
  • Fax: 702-710-6023

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-108100
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT1038
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: