Healthcare Provider Details

I. General information

NPI: 1700193653
Provider Name (Legal Business Name): CHRISTINE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHRISTINE SINGER

II. Dates (important events)

Enumeration Date: 09/13/2010
Last Update Date: 07/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

821 N MOJAVE RD
LAS VEGAS NV
89101-2407
US

IV. Provider business mailing address

821 N MOJAVE RD
LAS VEGAS NV
89101-2407
US

V. Phone/Fax

Practice location:
  • Phone: 702-642-7070
  • Fax: 702-649-3906
Mailing address:
  • Phone: 702-642-7070
  • Fax: 702-649-3906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: