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General NPI Number Information
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NPI Number | 1417563362
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Entity Type | Individual
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Provider Name | CARLOS RUBEN CISNEROS LCSW
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Gender | Male
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 4040 N MARTIN L KING BLVD STE A
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-3205
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Country | US
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Telephone | 702-644-4673
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Fax | 702-902-5443
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Provider Business Mailing Address
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Address Line | 4000 S EASTERN AVE STE 240
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City | LAS VEGAS
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State | NV
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Zip | 89119-0847
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Country | US
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Telephone | 702-799-9710
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 10518-C
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License Number State | NV
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