Provider Demographics
NPI:1063816015
Name:CISNEROS, MARTINIQUE N (RN)
Entity Type:Individual
Prefix:
First Name:MARTINIQUE
Middle Name:N
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:826 S OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-4732
Mailing Address - Country:US
Mailing Address - Phone:909-247-5842
Mailing Address - Fax:
Practice Address - Street 1:826 S OAKS AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-4732
Practice Address - Country:US
Practice Address - Phone:909-247-5842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-20
Last Update Date:2014-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA740538163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health