MEDICARE: CAMILLE CISNEROZ PH D

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	101YP2500X	Professional Counselor	0187171	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922372770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAMILLE CISNEROZ PH D

Provider Business Mailing Address
First Line	:	15885 S HIGHWAY 28
Second Line	:
City	:	LA MESA
State	:	NM
Zip	:	88044-9406
Country	:	US
Telephone Number	:	575-202-1394
Fax Number	:

Provider Business Practice Location Address
First Line	:	15885 S HIGHWAY 28
Second Line	:
City	:	LA MESA
State	:	NM
Zip	:	88044-9406
Country	:	US
Telephone Number	:	575-202-1394
Fax Number	:

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

Provider Enumeration Date	:	02/25/2012
Last Update Date	:	01/13/2025

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Directions to “ CAMILLE CISNEROZ PH D” Practice Location

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