Provider Demographics
NPI:1376211029
Name:CISNEROS, SARAH MARTINEZ (PA)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:MARTINEZ
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1363 ADRIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:NYSSA
Mailing Address - State:OR
Mailing Address - Zip Code:97913-5107
Mailing Address - Country:US
Mailing Address - Phone:541-216-1749
Mailing Address - Fax:
Practice Address - Street 1:2327 SW 4TH AVE
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-1851
Practice Address - Country:US
Practice Address - Phone:208-642-7364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical