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NPI Code Detail

MEDICARE: KAREN CISNEROS

MEDICARE: KAREN 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
1101YA0400XAddiction (Substance Use Disorder) CounselorCA

General Provider Information

NPI Number : 1629823182
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN CISNEROS
Provider Business Mailing Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number : 310-398-5690
Provider Business Practice Location Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number : 310-398-5690
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/18/2024
Last Update Date : 01/30/2026

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Directions to “ KAREN CISNEROS ” Practice Location

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