Provider Demographics
NPI:1063664456
Name:CISNEROS, ERIN MALIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MALIA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3033 NUTE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4312
Mailing Address - Country:US
Mailing Address - Phone:808-269-4054
Mailing Address - Fax:
Practice Address - Street 1:4231 BALBOA AVE # 1465
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5504
Practice Address - Country:US
Practice Address - Phone:808-269-4054
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist