Healthcare Provider Details

I. General information

NPI: 1043127657
Provider Name (Legal Business Name): ALEXA MICHELLE CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17902 W LAKE HOUSTON 77346
HUMBLE TX
77346
US

IV. Provider business mailing address

106 ROBMORE ST
HOUSTON TX
77076-3618
US

V. Phone/Fax

Practice location:
  • Phone: 281-306-3231
  • Fax:
Mailing address:
  • Phone: 832-472-6129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: