Healthcare Provider Details

I. General information

NPI: 1982571733
Provider Name (Legal Business Name): ARIANNA LISSETT CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 RACE ST
FORT WORTH TX
76111-4117
US

IV. Provider business mailing address

2320 CHRIS CT
GRAND PRAIRIE TX
75050-4063
US

V. Phone/Fax

Practice location:
  • Phone: 682-564-5476
  • Fax:
Mailing address:
  • Phone: 469-693-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: