Provider Demographics
NPI:1235129263
Name:CISNEROS, LUIS A (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:CISNEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8042 WURZBACH RD
Mailing Address - Street 2:STE 280
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3818
Mailing Address - Country:US
Mailing Address - Phone:210-614-8100
Mailing Address - Fax:210-568-0311
Practice Address - Street 1:1200 BROOKLYN AVE STE 365
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4810
Practice Address - Country:US
Practice Address - Phone:210-224-9616
Practice Address - Fax:210-224-5822
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXG1633207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128769006Medicaid
B21867Medicare UPIN
TX128769006Medicaid