Provider Demographics
NPI:1467595462
Name:CISNEROS, MARTHA JULIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:JULIA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:330 WEST LAS TUNAS DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91176
Mailing Address - Country:US
Mailing Address - Phone:626-284-3300
Mailing Address - Fax:626-284-3307
Practice Address - Street 1:888 S RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3831
Practice Address - Country:US
Practice Address - Phone:702-877-8690
Practice Address - Fax:702-877-5341
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2016-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000929363LX0001X
CANP6027363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology