Healthcare Provider Details

I. General information

NPI: 1083143010
Provider Name (Legal Business Name): MRS. WHITNEY CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2017
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4606 CENTERVIEW
SAN ANTONIO TX
78228-1214
US

IV. Provider business mailing address

223 HIGHWAY DR
SAN ANTONIO TX
78219-4007
US

V. Phone/Fax

Practice location:
  • Phone: 210-598-6486
  • Fax:
Mailing address:
  • Phone: 210-598-6486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90960
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: