=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932051133
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DJARIS CISNEROS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2026
-----------------------------------------------------
Last Update Date | 02/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2400 S LEES SUMMIT RD
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-1937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-986-0444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2400 S LEES SUMMIT RD
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64055-1937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-986-0444
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number | 1999134831
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------