Provider Demographics
NPI:1629109558
Name:JOSE S CISNEROS MD PA
Entity Type:Organization
Organization Name:JOSE S CISNEROS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:S
Authorized Official - Last Name:CISNEROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-548-1959
Mailing Address - Street 1:PO BOX 5328
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521
Mailing Address - Country:US
Mailing Address - Phone:956-548-1959
Mailing Address - Fax:956-548-1921
Practice Address - Street 1:1001 CALLE MILAGROS
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:956-548-1959
Practice Address - Fax:956-548-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4660207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0055HBOtherBCBS PROVIDER
TX8B2217Medicare ID - Type Unspecified
TX0055HBOtherBCBS PROVIDER
TX00803VMedicare ID - Type Unspecified