MEDICARE: CELESTE Z 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	363LP2300X	Primary Care Nurse Practitioner	1089047	TX

General Provider Information

NPI Number	:	1396463295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELESTE Z CISNEROS

Provider Business Mailing Address
First Line	:	6633 N MESA ST STE 508
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4427
Country	:	US
Telephone Number	:	915-266-3174
Fax Number	:	915-205-7878

Provider Business Practice Location Address
First Line	:	6633 N MESA ST STE 508
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-4427
Country	:	US
Telephone Number	:	915-266-3174
Fax Number	:	915-205-7878

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

Provider Enumeration Date	:	08/16/2022
Last Update Date	:	04/20/2025

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Directions to “ CELESTE Z CISNEROS ” Practice Location

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