MEDICARE: CLAUDIA ISABEL CISNEROS SAM

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1801605746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAUDIA ISABEL CISNEROS SAM

Provider Business Mailing Address
First Line	:	2120 N 65TH WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4023
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2120 N 65TH WAY
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4023
Country	:	US
Telephone Number	:	954-639-3498
Fax Number	:

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

Provider Enumeration Date	:	01/06/2025
Last Update Date	:	01/06/2025

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Directions to “ CLAUDIA ISABEL CISNEROS SAM ” Practice Location

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