Provider Demographics
NPI:1487378147
Name:GONZALEZ CISNEROS, IRMA
Entity type:Individual
Prefix:
First Name:IRMA
Middle Name:
Last Name:GONZALEZ CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:806 BARBERA WAY
Mailing Address - Street 2:
Mailing Address - City:GONZALES
Mailing Address - State:CA
Mailing Address - Zip Code:93926-9440
Mailing Address - Country:US
Mailing Address - Phone:831-229-5196
Mailing Address - Fax:
Practice Address - Street 1:200 BROADWAY ST STE 70
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2866
Practice Address - Country:US
Practice Address - Phone:831-386-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker