Provider Demographics
NPI:1114228954
Name:CISNEROS, DOLORES M
Entity Type:Individual
Prefix:
First Name:DOLORES
Middle Name:M
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 VENADITO TRL
Mailing Address - Street 2:
Mailing Address - City:ANTHONY
Mailing Address - State:NM
Mailing Address - Zip Code:88021-9050
Mailing Address - Country:US
Mailing Address - Phone:915-820-9275
Mailing Address - Fax:
Practice Address - Street 1:2200 VENADITO TRL
Practice Address - Street 2:
Practice Address - City:ANTHONY
Practice Address - State:NM
Practice Address - Zip Code:88021-9050
Practice Address - Country:US
Practice Address - Phone:915-820-9275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator