Provider Demographics
NPI:1427399567
Name:CISNEROS, BETSY ANN
Entity Type:Individual
Prefix:MS
First Name:BETSY
Middle Name:ANN
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BETSY
Other - Middle Name:ANN
Other - Last Name:JARQUIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18623 GALE AVE
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1342
Mailing Address - Country:US
Mailing Address - Phone:626-839-0300
Mailing Address - Fax:626-839-1780
Practice Address - Street 1:18623 GALE AVE
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1342
Practice Address - Country:US
Practice Address - Phone:626-839-0300
Practice Address - Fax:626-839-1780
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-14
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator