Provider Demographics
NPI:1063185932
Name:CISNEROS, JASMINE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:JASMINE
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5782 MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2126
Mailing Address - Country:US
Mailing Address - Phone:714-350-2769
Mailing Address - Fax:
Practice Address - Street 1:17692 BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6810
Practice Address - Country:US
Practice Address - Phone:714-847-6975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95181844163WM0705X
CA95018913363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical