Healthcare Provider Details

I. General information

NPI: 1336449719
Provider Name (Legal Business Name): GABRIEL CISNEROS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 03/25/2021
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 WILKINS AVE STE 202 SUITE 202
PITTSBURGH PA
15217-1282
US

IV. Provider business mailing address

5608 WILKINS AVE STE 202 SUITE 202
PITTSBURGH PA
15217-1282
US

V. Phone/Fax

Practice location:
  • Phone: 412-422-3590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD445584
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: