Provider Demographics
NPI:1699115089
Name:CISNEROS, OSCAR
Entity type:Individual
Prefix:MR
First Name:OSCAR
Middle Name:
Last Name:CISNEROS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2502 E. HUNTINGTON DRIVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91601-3155
Mailing Address - Country:US
Mailing Address - Phone:626-357-1514
Mailing Address - Fax:626-288-1026
Practice Address - Street 1:2502 E. HUNTINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91601-3155
Practice Address - Country:US
Practice Address - Phone:626-357-1514
Practice Address - Fax:626-288-1026
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator