Basic Information
| Provider Information | |||||||||
| NPI: | 1316079478 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISNEROS | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | NOEMI | ||||||||
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| Credential: | MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10551 LANGMUIR AVE | ||||||||
| Address2: | |||||||||
| City: | SUNLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910402910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8184089668 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14535 SHERMAN CIR | ||||||||
| Address2: | |||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189014930 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2007 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 112477 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.