Provider Demographics
NPI:1689895856
Name:CISNEROS, ALFRED LUIS (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:LUIS
Last Name:CISNEROS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11781 STONEY PEAK DR.
Mailing Address - Street 2:#2624
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-6433
Mailing Address - Country:US
Mailing Address - Phone:858-487-4806
Mailing Address - Fax:
Practice Address - Street 1:11781 STONEY PEAK DR.
Practice Address - Street 2:#2624
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-6433
Practice Address - Country:US
Practice Address - Phone:858-487-4806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology