Basic Information
| Provider Information | |||||||||
| NPI: | 1396335840 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISNEROS | ||||||||
| FirstName: | BLANCA | ||||||||
| MiddleName: | ESTELA | ||||||||
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| Credential: | SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6611 BOEING DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799251010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9157806576 | ||||||||
| FaxNumber: | 9157805303 | ||||||||
| Practice Location | |||||||||
| Address1: | 10662 VISTA DEL SOL DR | ||||||||
| Address2: | |||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799354520 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9158559333 | ||||||||
| FaxNumber: | 9158559213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2021 | ||||||||
| LastUpdateDate: | 01/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 110938 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 110938 | 01 | TX | LICENSE | OTHER |