Provider Demographics
NPI:1669451803
Name:CISNEROS, ROSA JUANITA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:JUANITA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9981 N WASHINGTON ST
Mailing Address - Street 2:SUITE 22
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2169
Mailing Address - Country:US
Mailing Address - Phone:303-252-1247
Mailing Address - Fax:303-569-6078
Practice Address - Street 1:9981 N WASHINGTON ST
Practice Address - Street 2:SUITE 22
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2169
Practice Address - Country:US
Practice Address - Phone:303-252-1247
Practice Address - Fax:303-569-6078
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO43511207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05629021Medicaid
COI49222Medicare UPIN