Provider Demographics
NPI:1518635853
Name:CISNEROS GUTIERREZ, DEYSI CAROLINA (BCBA)
Entity Type:Individual
Prefix:
First Name:DEYSI
Middle Name:CAROLINA
Last Name:CISNEROS GUTIERREZ
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5909 CARROTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93313-9462
Mailing Address - Country:US
Mailing Address - Phone:661-912-3956
Mailing Address - Fax:
Practice Address - Street 1:4900 CALIFORNIA AVE STE 100A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-7027
Practice Address - Country:US
Practice Address - Phone:661-843-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-21-52473103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst