Healthcare Provider Details

I. General information

NPI: 1942960323
Provider Name (Legal Business Name): PERLA PATRICIA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2021
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 S SUGAR RD STE 105
EDINBURG TX
78539-9140
US

IV. Provider business mailing address

4302 S SUGAR RD STE 105
EDINBURG TX
78539-9140
US

V. Phone/Fax

Practice location:
  • Phone: 956-287-3099
  • Fax: 956-517-1521
Mailing address:
  • Phone: 956-287-3099
  • Fax: 956-517-1521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: