Provider Demographics
NPI:1215759808
Name:CISNEROS-BECERRA, DAISY C (PA-S1)
Entity type:Individual
Prefix:
First Name:DAISY
Middle Name:C
Last Name:CISNEROS-BECERRA
Suffix:
Gender:F
Credentials:PA-S1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1075 E BETTERAVIA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4733
Mailing Address - Country:US
Mailing Address - Phone:805-621-7651
Mailing Address - Fax:
Practice Address - Street 1:1075 E BETTERAVIA RD
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7023
Practice Address - Country:US
Practice Address - Phone:805-621-7651
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-25
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program