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General NPI Number Information
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NPI Number | 1912621384
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Entity Type | Individual
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Provider Name | NANCY CISNEROS
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Gender | Female
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Dates
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Enumeration Date | 09/29/2022
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Last Update Date | 09/29/2022
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Provider Practice Location Address
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Address Line | 15405 LANSDOWNE RD
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City | TUSTIN
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State | CA
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Zip | 92782-0200
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Country | US
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Telephone | 714-566-8432
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Fax |
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Provider Business Mailing Address
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Address Line | 4358 MAXSON RD
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City | EL MONTE
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State | CA
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Zip | 91732-2048
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Country | US
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Telephone | 714-658-5992
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | AII051470218
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License Number State | CA
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