Basic Information
| Provider Information | |||||||||
| NPI: | 1730300468 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CISNEROS | ||||||||
| FirstName: | KAREN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7500 SPLENDID WAY | ||||||||
| Address2: | |||||||||
| City: | ELK GROVE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 957589544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9162611863 | ||||||||
| FaxNumber: | 5103760759 | ||||||||
| Practice Location | |||||||||
| Address1: | 6615 VALLEY HI DR | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958234601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9166816300 | ||||||||
| FaxNumber: | 5303760759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2007 | ||||||||
| LastUpdateDate: | 01/19/2009 | ||||||||
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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 | 42397 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.