Provider Demographics
NPI:1629766498
Name:SISNEROS, CHLOE EVE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:EVE
Last Name:SISNEROS
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 1:15441 MCCANN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHGATE
Mailing Address - State:MI
Mailing Address - Zip Code:48195-2643
Mailing Address - Country:US
Mailing Address - Phone:734-642-7908
Mailing Address - Fax:
Practice Address - Street 1:15441 MCCANN ST
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2643
Practice Address - Country:US
Practice Address - Phone:734-642-7908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program