Healthcare Provider Details

I. General information

NPI: 1366161440
Provider Name (Legal Business Name): VERONICA CISNEROS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 08/23/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 S JACKSON ST
SEATTLE WA
98144-2271
US

IV. Provider business mailing address

2010 S JACKSON ST
SEATTLE WA
98144-2271
US

V. Phone/Fax

Practice location:
  • Phone: 206-812-4373
  • Fax:
Mailing address:
  • Phone: 206-812-7373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: