Provider Demographics
NPI:1346324332
Name:CISNEROS-SEIBEL, PHILIP (PHD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:CISNEROS-SEIBEL
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:845 FORT STOCKTON DR UNIT 514
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-6707
Mailing Address - Country:US
Mailing Address - Phone:330-212-8706
Mailing Address - Fax:
Practice Address - Street 1:3734 6TH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-4317
Practice Address - Country:US
Practice Address - Phone:302-128-7063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30970103T00000X
OH4558103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0150223Medicaid
OHSECP14962OtherPIN
OH0150223Medicaid