Provider Demographics
NPI:1588363212
Name:CISNEROS, DAVID ANDREW (PT, DPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:CISNEROS
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5156 LOMA VERDE
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-6450
Mailing Address - Country:US
Mailing Address - Phone:760-560-7227
Mailing Address - Fax:
Practice Address - Street 1:740 LOMAS SANTA FE DR STE 208
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-1441
Practice Address - Country:US
Practice Address - Phone:760-452-2640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA303823225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist