Healthcare Provider Details

I. General information

NPI: 1992151419
Provider Name (Legal Business Name): LINA CISNEROS SLP-ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2016
Last Update Date: 09/13/2021
Certification Date: 09/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E OVILLA RD STE A
RED OAK TX
75154-2460
US

IV. Provider business mailing address

309 MESA CT
GLENN HEIGHTS TX
75154-8518
US

V. Phone/Fax

Practice location:
  • Phone: 469-850-5433
  • Fax:
Mailing address:
  • Phone: 210-414-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number38781
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: