Provider Demographics
NPI:1346752102
Name:CISNEROS, ANA KAREN
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:KAREN
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 1:3507 JAIME ZAPATA MEMORIAL HWY STE 7A
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-4770
Mailing Address - Country:US
Mailing Address - Phone:956-753-5600
Mailing Address - Fax:956-753-5602
Practice Address - Street 1:3507 JAIME ZAPATA MEMORIAL HWY STE 7A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4770
Practice Address - Country:US
Practice Address - Phone:956-753-5600
Practice Address - Fax:956-753-5602
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX404542355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX40454OtherSTATE LICENSE