Healthcare Provider Details

I. General information

NPI: 1235129263
Provider Name (Legal Business Name): LUIS A CISNEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BROOKLYN AVE STE 365
SAN ANTONIO TX
78212-4810
US

IV. Provider business mailing address

7940 FLOYD CURL DR STE 560
SAN ANTONIO TX
78229-3907
US

V. Phone/Fax

Practice location:
  • Phone: 210-224-9616
  • Fax: 210-224-5822
Mailing address:
  • Phone: 210-614-8100
  • Fax: 210-568-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG1633
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: