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General NPI Number Information
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NPI Number | 1821242157
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Entity Type | Organization
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Legal Business Name | GREGORY A. CISNEROS MD PA
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Dates
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Enumeration Date | 11/13/2008
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Last Update Date | 11/13/2008
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Provider Practice Location Address
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Address Line | 33 OLD KINGS RD N SUITE 2
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City | PALM COAST
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State | FL
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Zip | 32137-8227
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Country | US
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Telephone | 386-263-2718
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Fax |
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Provider Business Mailing Address
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Address Line | 33 OLD KINGS RD N SUITE 2
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City | PALM COAST
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State | FL
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Zip | 32137-8227
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Country | US
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Telephone | 386-263-2718
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | GREGORIO A CISNEROS
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Credential | M.D.
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Telephone | 386-263-2718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME84611
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License Number State | FL
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