Healthcare Provider Details

I. General information

NPI: 1912431206
Provider Name (Legal Business Name): ALICIA E CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6207 SHERIDAN AVE
AUSTIN TX
78723-1060
US

IV. Provider business mailing address

835 ISOM RD
SAN ANTONIO TX
78216-4035
US

V. Phone/Fax

Practice location:
  • Phone: 737-704-4234
  • Fax: 512-334-4465
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number118243
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: