Provider Demographics
NPI:1194706408
Name:CISNEROS-SEIBEL, GERARDO (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:
Last Name:CISNEROS-SEIBEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:858-605-7171
Mailing Address - Fax:
Practice Address - Street 1:7565 MISSION VALLEY RD STE 200S91
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4431
Practice Address - Country:US
Practice Address - Phone:619-245-2810
Practice Address - Fax:330-456-9476
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35076345207R00000X
CA161010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157366Medicaid
OH2168872Medicaid
1902827876OtherGROUP NPI
OHC14022031Medicare ID - Type Unspecified
OH2168872Medicaid