Healthcare Provider Details

I. General information

NPI: 1922498112
Provider Name (Legal Business Name): DR. STEVE GARCIA CISNEROS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 NE 13TH ST # 116A
OKLAHOMA CITY OK
73104-5007
US

IV. Provider business mailing address

333 NW 5TH ST APT 1607
OKLAHOMA CITY OK
73102-3000
US

V. Phone/Fax

Practice location:
  • Phone: 405-456-5733
  • Fax:
Mailing address:
  • Phone: 312-799-9988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0005123
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY.0005123
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: