Provider Demographics
NPI:1063664456
Name:CISNEROS, ERIN MALIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:MALIA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1498
Mailing Address - Street 2:
Mailing Address - City:KIHEI
Mailing Address - State:HI
Mailing Address - Zip Code:96753-1498
Mailing Address - Country:US
Mailing Address - Phone:808-269-4054
Mailing Address - Fax:
Practice Address - Street 1:1787 WILI PA LOOP SUITE 7
Practice Address - Street 2:SUITE 7
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793
Practice Address - Country:US
Practice Address - Phone:808-249-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist