Provider Demographics
NPI:1033843446
Name:CISNEROS, JESUS PASCUAL
Entity Type:Individual
Prefix:
First Name:JESUS
Middle Name:PASCUAL
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 1:2351 WESTWOOD CT APT F1
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-5156
Mailing Address - Country:US
Mailing Address - Phone:773-573-6091
Mailing Address - Fax:
Practice Address - Street 1:2351 WESTWOOD CT APT F1
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-5156
Practice Address - Country:US
Practice Address - Phone:773-573-6091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator