Healthcare Provider Details

I. General information

NPI: 1356042840
Provider Name (Legal Business Name): ELIZABETH ANDREA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2121 MIDWAY RD STE 145
CARROLLTON TX
75006-5263
US

IV. Provider business mailing address

2121 MIDWAY RD STE 145
CARROLLTON TX
75006-5263
US

V. Phone/Fax

Practice location:
  • Phone: 972-851-1022
  • Fax:
Mailing address:
  • Phone: 972-851-1022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: