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General NPI Number Information
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NPI Number | 1376211029
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Entity Type | Individual
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Provider Name | SARAH MARTINEZ CISNEROS PA
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Gender | Female
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Dates
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Enumeration Date | 08/30/2021
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 2327 SW 4TH AVE
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City | ONTARIO
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State | OR
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Zip | 97914-1851
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Country | US
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Telephone | 208-642-7364
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 NE 10TH AVE
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City | PAYETTE
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State | ID
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Zip | 83661-5420
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Country | US
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Telephone | 208-642-9376
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Fax | 208-642-9598
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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