Basic Information
| Provider Information | |||||||||
| NPI: | 1376211029 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISNEROS | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARTINEZ | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1363 ADRIAN BLVD | ||||||||
| Address2: | |||||||||
| City: | NYSSA | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979135107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412161749 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2327 SW 4TH AVE | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979141851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086427364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2021 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.