MEDICARE: NOE RODRIGUEZ-CISNEROS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist		CA

General Provider Information

NPI Number	:	1285514414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOE RODRIGUEZ-CISNEROS

Provider Business Mailing Address
First Line	:	1308 PEPPER TREE LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-5428
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 PEPPER TREE LN
Second Line	:
City	:	SAN BERNARDINO
State	:	CA
Zip	:	92404-5428
Country	:	US
Telephone Number	:	909-919-6635
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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