Healthcare Provider Details

I. General information

NPI: 1396463295
Provider Name (Legal Business Name): CELESTE Z CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 04/20/2025
Certification Date: 04/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 N MESA ST STE 508
EL PASO TX
79912-4427
US

IV. Provider business mailing address

6633 N MESA ST STE 508
EL PASO TX
79912-4427
US

V. Phone/Fax

Practice location:
  • Phone: 915-266-3174
  • Fax: 915-205-7878
Mailing address:
  • Phone: 915-266-3174
  • Fax: 915-205-7878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number1089047
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: