Provider Demographics
NPI:1609370303
Name:CISNEROS, ANA ESTHER
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ESTHER
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 1:26780 SW 142ND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-5420
Mailing Address - Country:US
Mailing Address - Phone:786-286-1339
Mailing Address - Fax:
Practice Address - Street 1:26780 SW 142ND AVE APT 202
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-5420
Practice Address - Country:US
Practice Address - Phone:786-286-1339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2020-08-25
Deactivation Date:2019-09-04
Deactivation Code:
Reactivation Date:2020-08-25
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician