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1861384513 NPI number — EDUARDO J CISNEROS

NPI Number: 1861384513
Health Care Provider/Practitioner: EDUARDO J CISNEROS

Information about “1861384513” NPI (EDUARDO J CISNEROS) exists in 1861384513 in HTML format HTML  |  1861384513 in plain Text format TXT  |  1861384513 in PDF (Portable Document Format) PDF  |  1861384513 in an XML format XML  formats.

NPI Number : 1861384513 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861384513",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CISNEROS",
    "FirstName": "EDUARDO",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4824 N TRIPP AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60630-2721",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-320-1971",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5 REVERE DR STE 200",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORTHBROOK",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60062-8000",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "312-600-3991",
    "PracticeLocationAddressFaxNumber": "630-473-2232",
    "EnumerationDate": "07/17/2025",
    "LastUpdateDate": "12/31/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "209034192",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "163WP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Registered Nurse",
          "LicenseNumber": "041524344",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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