Healthcare Provider Details

I. General information

NPI: 1346752102
Provider Name (Legal Business Name): ANA KAREN CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2017
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 JAIME ZAPATA MEMORIAL HWY STE 7A
LAREDO TX
78043-4770
US

IV. Provider business mailing address

3507 JAIME ZAPATA MEMORIAL HWY STE 7A
LAREDO TX
78043-4770
US

V. Phone/Fax

Practice location:
  • Phone: 956-753-5600
  • Fax: 956-753-5602
Mailing address:
  • Phone: 956-753-5600
  • Fax: 956-753-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number40454
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: