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General NPI Number Information
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NPI Number | 1669830246
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Entity Type | Individual
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Provider Name | HENRY CISNEROS III
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Gender | Male
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 02/10/2016
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Provider Practice Location Address
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Address Line | 1870 S CENTRAL ST 203
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City | VISALIA
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State | CA
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Zip | 93277-4418
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Country | US
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Telephone | 559-636-1200
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Fax | 559-636-1260
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Provider Business Mailing Address
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Address Line | 4930 W KAWEAH CT STE 203
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City | VISALIA
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State | CA
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Zip | 93277-8316
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Country | US
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Telephone | 559-713-6806
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Fax | 559-713-6809
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT35279
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License Number State | CA
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