Healthcare Provider Details

I. General information

NPI: 1396335840
Provider Name (Legal Business Name): BLANCA ESTELA CISNEROS SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 01/19/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10662 VISTA DEL SOL DR
EL PASO TX
79935-4520
US

IV. Provider business mailing address

6611 BOEING DR
EL PASO TX
79925-1010
US

V. Phone/Fax

Practice location:
  • Phone: 915-855-9333
  • Fax: 915-855-9213
Mailing address:
  • Phone: 915-780-6576
  • Fax: 915-780-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number110938
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: